Custom-made approach to a patient with post-burn breast deformity

Abstract

Second and third degree burns on breasts at preadolescent period may cause severe breast deformations. This deformation can be variable depending on severity and location of the burns, personal adolescent patterns, and treatment modality in acute burn period. A 21 year old female patient admitted to our department for her breast deformation due to burn contracture at the inferior pole of the right breast. On physical examination we defined that development of the volume of the right breast was equal to the left, and inferior pole of the right breast was flattened due to contracture, and nipple was projected to inferior. We found that inframammary crease of the right breast was 2 cm lower than that of left; andthe distance of nipple-inframamary crease was 4.7 cm while areola-inframmary crease was 2 cm. New nipple-areola complex level was identified according to left breast's level. Medial and lateral lines were planned to merge inferiorly at 2 cm above inframmary crease in a plan similar to vertical mammaplasty. Superior pedicle carrying nipple areola was desepitelised. Lower parenchymal V flap was transposed superiorly and attached to the pectoral muscle. Inferior parts of the lateral and medial glandular flaps were excised to form new inframammary crease. The desired laxity of skin at the lower pole was obtained by performing a new Z- plasty between lateral and medial skin flaps. Breast symmetry was confirmed by postoperative objective measurements between left and right breasts. Patient's satisfaction and aesthetic appearance levels were high. Breasts deformation patterns caused by burns, trauma and mass exsicion due to cancer could not be addressed with traditional defined techniques. Special deformations can be corrected by custom made plannings as we presented here.

Reconstruction of Acquired Breast Hypoplasia by Subcutaneous Scar Releasing and Repeated Fat Grafting Combination

“…5 Autologous fat grafting has been shown to increase microcirculation and neoangiogenesis in experimental studies. 3 Thirty to forty percent of infiltrated fat grafts reabsorb within 1 year, and this ratio decreased in repeated attempts, which has been shown in the literature. 6 …”

“…Z-plasty, excision, scar releasing, skin grafts, flaps, tissue expanders, and fat grafts are useful reconstructive alternatives in the treatment of fibrotic and restricted scars. 1 – 3 …”

“…For secondary deformities such as traumatic or postinfectious scars, Z-plasties, scar excisions, or relaxations, skin grafts and flaps can be used in addition to basic breast reconstruction techniques. 3 …”

A rare approach? Microsurgical breast reconstruction after severe burns

“…Various operative techniques have been used to address postburn breast deformities, including tissue expansion and silicone implants, as well as using skin grafts, artificial dermal substitutes, or local muscle flaps in combination with symmetrizing techniques such as mastopexy or reduction mammoplasty 4 5 6 7 8 . Free-tissue reconstruction has been suggested as an alternative technique, but to our knowledge, there are no experiential reports of larger case series where this technique was used 9 10 .…”

Evaluation of Ideal Surgical Method for Management of Post Burn Scar Contracture of Neck

“…Reconstructive techniques are applied in a hierarchy, as per the reconstructive ladder, starting from the simplest procedure like Split Skin Grafts on the first step to compound tissue transfer by Micro vascular surgery at the other extreme. [5,6] Patients suffering from physical and psychological pain of burn injury and disfigurement are in need of a special level of caring. These patients not only require technical expertise but also a great deal of surgeon's time, understanding and compassion.…”