Is It Safe to Undergo a Rib Cartilage Rhinoplasty if I Have Had Pneumothorax Once Before?

The main major risk in rib cartilage is pneumothorax.  When a patient has a previous pneumothorax there is a chance of scarring of the pleura to a superficial area which can lead to the pleura more accessible to damage.  Typically the pleura of the lung is located underneath the rib but it can be located in between the rib.  This would make a pneumothorax a higher chance in your case and may mean considering harvesting rib from the contralateral side to the pneumothorax or using an alternative cartilage source.Cartilage in rhinoplasty is used for support and structure to the nose. The three most commonly used donor areas in rhinoplasty areSeptal cartilage (often missing in revision rhinoplasty) and made of fibroelastic cartilageEar cartilage -softer cartilage and is elastic type of cartilage (hence softer and likely to bend)Rib or costal cartilage- firmer cartilage and similar in makeup as septal cartilageThe main risks of harvesting costal cartilage are as follows:Warping-This risk can be minimized with experience of carving rhinoplasty, patients with calcifications in the rib, and the location and type of graft placementScar- The scar size can be minimized based on the patient's body type (thinner patients can have a smaller scar) and surgeon's experience with more advanced surgeon's harvesting from 1-3 cm rib scarsPneumothorax- This is where a lung deflates since the surgeon is working around the rib site. This is rare but the surgeon must be able to handle this risk.Breast implant violation- Patients with breast implants may be at risk for a "popped" implant although this is unlikelyAlthough there are some risks with rib cartilage, the benefits can often outweigh the risks as it costal cartilage is strong and abundant in younger and middle aged patients. For revision rhinoplasty, patients should seek out surgeons with experience in using rib cartilage as results may be compromised without enough cartilage or the sole use of ear cartilage in certain circumstances.

One of the risks of rib harvest is a pneumothorax. Since you have had a previous one, I personally would harvest from the opposite side to avoid any further risks to that particular lung. Good luck.

Your risk is low of rib grafting causing another pneumothorax. The general anesthesia could be a factor if you have pulmonary blebs. An anesthetist should be made aware of your history. You could also consider alternatives to rib including ear cartilage, septal grafts and gortex implants

There is probably no real connection between your prior spontaneous pneumothorax and one caused by harvesting a rig graft. As long as a puncture is recognized the danger is low. You might want to consider other methods of dorsal augmentation, such as diced donor cartilage wrapped in fascia. This has been a successful alternative method for raising the nasal bridge. Not every patient needs a rib graft.

A pneumothorax is rare during rib graft harvest regardless of whether you've had prior spontaneous pneumothorax. With that said, pneumothorax resulting from rib graft harvest is very uncommon but easily and immediately detectable and quickly remedied. I would discuss this with your surgeon AND your anesthesiologist prior to surgery. Make sure you communicate your history clearly and seek an experienced rhinoplasty surgeon. With your history, I would highly recommend that you seek out an accredited ASC with MD anesthesiologists on the slim possibility that you were to develop another pneumothorax. I hope this information is helpful.
Stephen Weber, M.D., F.A.C.S.
Lone Tree Facial Plastic Surgeon