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PEDIATRICS Vol. 111 No. 1 January 2003, pp. 80-86

Breast Deformity in Adolescence as a Result of Pneumothorax Drainage During Neonatal Intensive Care

Christian Rainer, MD*, Alexander Gardetto, MD*, Martin Frühwirth, MD{ddagger}, Rudolf Trawöger, MD{ddagger}, Romed Meirer, MD*, Helga Fritsch, MD§ and Hildegunde Piza-Katzer, MD*

* Department of Plastic and Reconstructive Surgery, University of Innsbruck and Ludwig-Boltzmann Institute for Quality Control in Plastic Surgery, Innsbruck, Austria
{ddagger} Department of Pediatrics
§ Institute of Anatomy and Histology, University of Innsbruck, Innsbruck, Austria

--> Objective. During intensive care of newborns, a number of invasive techniques may be necessary for resuscitation. The margin of safety between effective treatment and iatrogenic damage is narrow. The objective of this study was to identify and discuss iatrogenic damage in females resulting from treatment of pneumothorax and to give neonatologists anatomically based advice for prevention.

Patients and Methods. We report 2 female patients (aged 13 and 16 years) born prematurely in whom breast deformity occurred caused by drainage of multiple pneumothoraces during intensive care. In an additional anatomic study, both hemithoraces of 5 newborn female cadavers (n = 10) were dissected to measure the extension of the breast tissue.

Results. The anatomic investigations in newborns demonstrate that breast tissue extends vertically from the second or third rib to the sixth rib and from close to the sternal edge medially, almost to the anterior axillary line laterally.

Conclusion. Psychological distress and corrective surgery because of deformed breasts in adolescent girls who have undergone drainage of pneumothoraces as newborns can be avoided by placing the skin incision in the anterior axillary line, maintaining a distance of 4 to 5 cm inferior to the nipple, and by inserting the chest drain through the fifth or sixth intercostal space during neonatal treatment.

Key Words: pneumothorax • chest drain • breast deformity • iatrogenic damage

Received for publication Jan 28, 2002; Accepted Jun 11, 2002.


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