Brachial plexus injury after breast prosthesis exchange

Female patient who underwent mastopexy surgery and breast implant replacement on Agt 24, 2022. Postoperatively, she developed anesthesia and brachial paraplegia. She was prescribed Etna® and Dexador® and referred for physical therapy. She sought neurological consultation on Sep 1, 2022, reporting hypoesthesia, paresthesia (tingling), and weakness in the upper limbs. Physical examination (upper limbs): arm abduction (strength (S) grade 1 on the right and 3 on the left), flexion and extension of forearms (S grade 2), and hands (S grade 4); upper limb hypoesthesia; globally reduced deep tendon reflexes (DTR) grade 1; absent Hoffman sign. Upper limb nerve conduction studies were requested on Sep 16, 2022, revealing bilateral brachial plexopathy with signs of acute axonal loss. By September 22, 2022, there was partial improvement in upper limb weakness - arm abduction (S 2 on the right and 3 on the left), flexion and extension of forearms (S 4 on the left and 3 on the right), and hands (S 4). Dexador® and Etna® were gradually discontinued, and Millgama® and Pregabalin were prescribed along with continued physical therapy. Cervical spine MRI on Sep 30, 2022, showed a posterior central disc protrusion at C5-C6 level indenting the ventral aspect of the dural sac; brachial plexus MRI showed mild T2 hyperintensity. On Oct 20, 2022, the patient exhibited difficulty maintaining isometry, upper limb hypoesthesia, and paresthesia in the right thumb. Physical examination showed improved upper limb strength (S 4 in hands and forearms; S 3 in arm abduction and shoulder elevation), grade 2 brachioradialis reflex on the right, and grade 1 elsewhere. Medications and physical therapy were continued. At the last visit, the patient reported complete improvement in movements, reducing physical therapy sessions. Nerve conduction studies on Feb 3, 2023, did not reveal significant abnormalities, demonstrating clear improvement in electrophysiological patterns compared to previous studies. Neurological examination showed S 5 in both upper limbs, preserved tone, reflexes grade 2, and intact tactile sensation. The patient was discharged. Disscution Fernandes notes that most peripheral nervous system injuries involve the brachial plexus, mainly from traumas during shoulder manipulation, leading to functional and sensory loss. This case details brachial plexopathy post-breast reconstruction surgery, highlighting varied surgical techniques impacting outcomes. Initial assessment revealed proximal upper limb weakness on the Medical Research Council (MRC) Scale. Electromyography confirmed bilateral plexopathy, aligning with complex diagnostic challenges requiring advanced imaging. Follow-up showed muscle strength improvement and MRI findings suggesting transient plexopathy. Early suspicion and treatment led to full recovery in five months, emphasizing non-surgical intervention benefits. Clinical vigilance and prompt patient response significantly influenced prognosis.