A46-17 “The Breast Approach for Augmentation Associated Chylothorax” Non-Traumatic Right-Sided Chylothorax Secondary to Cisterna Chyli Maceration Associated With Ruptured Silicone Breast Implant

Introduction Chylothorax is the accumulation of chyle within the pleural space. It arises when the thoracic duct or its tributaries are disrupted or obstructed. Its anatomy allows injuries below the T5-T6 crossing to generally cause right-sided effusions, whereas injuries above the crossing usually cause left-sided effusions. This case presents a unique presentation of a chylothorax directly linked to breast implant rupture. Though widely used, silicone implants can provoke chronic pleural inflammation and a foreignbody reaction (FBR). Although capsular contracture, rupture, and infection are common implant complications, pleural effusion is extremely rare, and a chylothorax has never been directly linked. Case An 83-year-old female, lifelong nonsmoker with no pulmonary disease presents with one month of progressive dyspnea. Past medical history is notable for calcified right upper lobe granulomatous disease and bilateral silicone breast augmentation many years prior. She has decreased breath sounds over the right hemithorax, and chest radiograph demonstrates a large right-sided pleural effusion compressing the underlying lung. Thoracentesis drained 1.5 L of milky fluid with pleural analysis showing triglycerides >110 mg/dL with chylomicrons, confirming chylothorax. CT chest suggested rupture of the right silicone implant with surrounding inflammatory changes without further evidence of malignancy or traumatic injury. Management included chest tube placement with high-output chylous fluid drainage (>1 L/day) attempted low-fat diet, octreotide infusion but ultimately attempted Lymphangiography which showed irregular and macerated cisterna chyli, but any attempts at thoracic duct embolization were unsuccessful. Though the patient declined video-assisted thoracoscopic surgery (VATS) for thoracic duct ligation, chest tube output gradually declined on subcutaneous octreotide, allowing its removal. Patient was discharged home on nocturnal oxygen with plans for implant removal. Discussion The ruptured silicone implant induced a persistent FBR, characterized by macrophage activation and chronic cytokine production, as described in cases of silicone-related pleural effusions. Chronic inflammation, combined with prior granulomatous scarring, may have led to sustained lymphatic hypertension acting on an already fragile cisterna chyli wall, causing spontaneous rupture, producing a right-sided chyle leak. Previous implant-related reports describe serous or inflammatory effusions, however to our knowledge, this represents the first reported case of non-traumatic right-sided chylothorax due to cisterna chyli maceration. When evaluating unexplained pleural effusions, clinicians should consider the differential of chylothorax in patients with breast implants and check pleural triglycerides. Along with conservative management and thoracic duct embolization, timely removal of ruptured implants may reduce ongoing inflammation. This abstract is funded by: None