Use of Breast Implants to Fill Postinfarct Pneumonectomy Cavity in Cases of Bilateral Lung Transplantation Prashant N. Mohite, MCh, Bartlomeij Zych, MD, Anton Sabashnikov, MD, Nikhil Unune, DMRD, and Andre R. Simon, MD Department of Cardiothoracic Transplantation, Harefield Hospital, Harefield, Middlesex, United Kingdom I nfarction of the lung graft following lung transplanta- tion (LTx) needing graft pneumonectomy and retrans- plantation is rare and carries a poor prognosis. It is important to maintain the volume of hemithorax after pneumonectomy until retransplantation. A young woman who received bilateral LTx for idio- pathic pulmonary hypertension underwent left graft pneumonectomy owing to infarction related to obstruc- tion of pulmonary veins. After pneumonectomy, left hemithorax was filled with silicon breast implants (1  500 mL and 2  250 mL). A Taurolidine drip was started into the left chest cavity and was maintained 24 h/d for 5 d to avoid infection of breast implants (Fig 1). After 9 weeks when suitable single lung donor became available, the left chest was opened, the breast implants were removed, and a new organ was transplanted. The patient made a rapid recovery after retransplantation and was discharged home after 4 weeks. In another woman in her mid 40s with bilateral LTx for pulmonary fibrosis, two 500-mL implants were placed following left graft pneumonectomy for pul- monary artery obstruction (Fig 2). Gas exchange from a single lung was inadequate and required extracorporeal life support, from which she could not be weaned and died after 1 month from refractory liver failure. In these cases, graft pneumonectomy was performed within the first week of transplantation. The plan was to offer retransplantation as the patients’ condition stabilized and suitable donor organs became available. It was impor- tant to preserve the space in hemithorax, because medias- tinal shift, diaphragmatic elevation, and rib crowding seen after pneumonectomy would have obliterated it. The use of breast implants for filling the hemithorax preserved the space so that the retransplantation with an appropriately sized organ would be possible. Breast implants also had a tamponade effect and prevented bleeding from the hilum and chest wall after pneumonectomy. The risk of herniation of the heart through the pericardial rent made for hilar dissection of the native lung was also prevented by breast implants. Address correspondence to Dr Mohite, 6 Parkwood House, Harefield Hos- pital, Middlesex, United Kingdom UB9 6JH; e-mail: drprashantis@ rediffmail.com. Fig 1. Fig 2. © 2013 by The Society of Thoracic Surgeons Ann Thorac Surg 2013;95:e75 • 0003-4975/$36.00 Published by Elsevier Inc http://dx.doi.org/10.1016/j.athoracsur.2012.09.026