The burned female breast: a report on four cases

Postburn breast reconstruction: a scoping review

Introduction

Postburn breast deformities pose functional and aesthetic concerns for burn patients, particularly when injury occurs before puberty, as normal breast development may be hindered. Postburn breast reconstruction aims at restoration of native anatomic features, as well as re-establishment of symmetry. The objectives of this scoping review are to map the literature on scar management and breast reconstruction, highlighting strategies that are particular to postburn deformities, as well as to establish optimal timing principles.

Methods

A comprehensive search of the English literature across MEDLINE and EMBASE databases, including the grey literature, was conducted. Literature of all study designs were eligible, provided it discussed the treatment of postburn breast deformities.

Results

A total of 64 studies were included. The most common study design was case series (58%) followed by retrospective cohorts (28%). Scar contracture release with split thickness skin grafts (26%) and various techniques for nipple-areola reconstruction (22%) were the most common reconstructive procedures.

Discussion

Scar contracture releases predominate when there is normal breast development under a contracted skin envelope, and should be performed as soon as breast mound development is restricted. Surgical techniques widely used for postmastectomy reconstruction are required for patients with amastia or hypoplastic breasts.

Conclusion

Given the heterogeneity of defects, availability of donor sites, and patient preference, no standardized guideline is available. Surgeons should combine basic scar management principles with postmastectomy techniques, adapting the surgical approach to features that are particular to thermally injured patients, as well as taking into account ideal timing considerations.

Lay Summary

Breast deformities secondary to burn scars pose functional and aesthetic concerns for burn patients, particularly when injury occurs before puberty, as normal breast development may be hindered. Postburn breast reconstruction aims at restoration of native anatomic features, as well as re-establishment of symmetry. This literature review aimed at summarizing the available techniques to treat postburn breast deformities, as well as establishing optimal timing guidelines, given these issues may occur at any phase of breast development. When there is breast development under a scarred skin envelope, treatment entails scar contracture release and should be recommended as soon as the diagnosis is established, in order to allow the breast to further develop in an unrestricted manner. When there is absence of breast tissue, surgical techniques widely utilized for breast cancer reconstruction are warranted, and should be delayed until no further breast development is expected. Given the heterogeneity of deformities, availability of donor sites, and patience preference, no standardized guideline is available. Treatment options include several surgical techniques, in addition to non-surgical scar management, and timing considerations must take into account the patient's developmental phase and psychosocial wellness.

Total aesthetic reconstruction of postburn bilateral breast loss using transverse myocutaneous gracilis free flaps: A case report and literature review

Reconstruction of breast burns are challenging, as it includes both functional and aesthetic components. Transverse myocutaneous gracilis (TMG) flap has been used for postmastectomy breast reconstruction in the absence of abdominal donor site availability. Use of this flap for the breast burns is limited. A 32-year-old female sustained 54% second and third degree burns resulting with bilateral total breast loss. Anterior and posterior thorax, upper and mid abdomen, neck, shoulders, and bilateral upper extremities were also involved. Inner medial thighs had an ample amount of tissue and had never been used as donor sites. The left TMG (28 × 12 cm, 1,413 g) was used for right, and the right TMG (30 × 14 cm, 1,635 g) was used for the left breast, 3 months apart. The contracture on the chest wall was completely excised. Venous anastomosis to the venae commitantes was performed using a 2.5 mm coupler, followed by an end-to-end arterial anastomosis to the internal mammary artery. Flaps were inset in a fashion so that the inferior part became the inframammary fold, and the anterior and posterior wings were joined in the upper pole, creating a conical shape. Minimal wound dehiscence in the postoperative course healed with dressing changes and both flaps survived completely. Nipple reconstruction and areolar tattooing was performed. The patient was very happy with the outcome at seventh year follow-up. TMG may be a valuable option even in bilateral cases of microsurgical autologous free tissue transfer for total aesthetic reconstruction of postburn breast loss.

Autologous Breast Reconstruction Using a Tensor Fascia Lata/Anterior Lateral Thigh-Freestyle Flap After Extensive Electric Burn: A Case Report

AIMS

Reconstruction of breasts and chest wall deformities in female patients after severe burn injury is a challenge for reconstructive surgeons. In these patients, neither implant-based procedures nor standard free flaps are sometimes applicable because of limited skin quality and unavailability of donor sites at the abdomen, back, buttock, or medial thigh.

METHODS

We present a case of a young female patient with a history of 80 % total body surface area burn after electric high-voltage injury. The burn occurred at the age of 9 years, and during the initial treatment, the right breast required amputation because of deep, full-thickness burn. Because the rigid and instable scar including chronic wound developed and an implant-based breast reconstruction was not feasible, the choice of possible free flaps was limited to the right lateral/proximal thigh. Preoperative computed tomography angiography demonstrated 2 intact perforators branching off the lateral femoral circumflex artery and a combined 17 × 24-cm tensor fascia lata/anterior lateral thigh perforator flap with in-flap anastomosis was transferred to the right breast after wound debridement and histological exclusion of Majolin ulcer in the instable scar. The internal mammary vessels were chosen as recipient vessels, and the donor site was covered with a split-thickness skin graft.

RESULTS

The postoperative course was uneventful at the right breast; however, the recipient site healed secondarily at the proximal pole. The resulting breast asymmetry was corrected by lipofilling of the central zone of the reconstructed breast and new definition of the inframammary fold as well as a minor liposuction at the cranial margin of the flap. The patient was very satisfied with the result, and no further correction was necessary.

CONCLUSIONS

Autologous breast reconstruction is a valuable option for patients after severe burn injury. However, microsurgical expertise and an individualized and flexible surgical strategy are required for optimal reconstructive results. Computed tomography angiography is helpful for preoperative planning of the procedure.

Breast Reduction in the Burned Breast

Mammary hypertrophy can occur in the postburn breast. Patients with burned breasts exhibit the same symptoms of symptomatic macromastia as patients with unburned breasts. The extent of the deformity, the location of the deformity, and the status of the surrounding soft tissue are all assessed before embarking on any surgical plan, which then proceeds in a conservative stepwise fashion. Although many plastic surgeons are reluctant to operate on burned breasts for fear of devascularizing the skin graft or nipple areolar complex, reduction mammaplasty in this group of patients is safe and carries minimal risk if key concepts are followed.

Are augmentation mammaplasty and reconstruction of the burned breast collateral lines? Experience in performing simultaneous reconstructive and aesthetic surgery

Anterior chest burns in young females frequently result in complicated problems such as scar contracture, damage to the nipple-areolar complex and breast tissue. Furthermore, an absent breast mound, hypoplasia or disfigurement of developed breasts can result in breast asymmetry and psychological problems. So we presented an alternative procedure that combines burn scar reconstruction and augmentation mammaplasty performed during one operative session. We believe patients who have either smaller natural breasts or burned breast with anterior chest scar contracture can earn both functional and aesthetic benefits via this simultaneous operation.