Thoracic Outlet Syndrome After Implant-based Breast Reconstruction

Background: Thoracic outlet syndrome (TOS) is characterized by compression of neurovascular structures within the thoracic outlet. Symptoms include upper-extremity paresthesias, weakness, and, in some-cases, effort-induced thrombosis. Implant-based breast reconstruction has been identified as a potential etiology of TOS given the anatomic relationship of the pectoralis muscles to the thoracic outlet. This study aims to investigate the relationship between implant-based reconstruction and TOS diagnosis. Methods: A retrospective, single-institution review was conducted to identify female subjects that presented for evaluation of TOS-like symptoms between April 2014 and December 2022. Results: 319 female patients presented to our institution for evaluation. Sixteen (5.0%) of these subjects previously underwent implant-based breast reconstruction, for which the following outcomes were considered: symptom type, timing to onset of symptoms relative to timing of reconstruction, and diagnosis of TOS as confirmed by imaging or testing. Seven of 16 patients (43.8%) received a formal diagnosis of TOS from a surgical specialist and were also found to have subpectoral implants. Conclusions: Based on clinical evidence, breast reconstruction has been acknowledged as a probable etiology for TOS. However, over half of symptomatic subjects did not receive a formal diagnosis of TOS, suggesting a potential for improvement in screening methods for this population. While the data of this study suggests that the plane of reconstruction, specifically subpectoral, could have an association with TOS, further research with a larger patient cohort is necessary to establish a definitive causal relationship.