A rare approach? Microsurgical breast reconstruction after severe burns

Abstract

Breast deformity, in post-burn patients, is a common problem leading to lower self-esteem and reclusive behavior that impairs quality of life. The authors present the course of treatment of an 18-year-old immigrant girl who suffered second- to third-degree burns over approximately 20% of her total body surface area in her early childhood. The second- to third-degree burns were located on her right trunk and abdomen, as well as her right shoulder, neck, and right groin area. Since it was not offered in her home country, reconstructive surgery, including microsurgical breast reconstruction, was sought abroad. Due to the lack of available skin and soft tissue, a bilateral breast reconstruction with free transverse myocutaneous gracilis flaps was offered. This case illustrates one method of using microsurgery to address post-burn breast deformities in order to alleviate psychological suffering and improve quality of life.

Postburn breast reconstruction: a scoping review

“…42 Popular abdominal flaps include the TRAM and DIEP flaps; however, lack of skin laxity and scars to the lower abdomen may prevent their use. 4,22,43 Other options reported include a vertically-oriented thoracodorsal artery perforator (TDAP) flap, 2 transverse myocutaneous gracilis flap, 44,45 and unconventional flap designs given local deformities, such as the one reported by Boehm et al, which combines a tensor fascia lata with ALT flap. 42 For patients with no available autologous tissue transfer options or who prefer to be treated with alloplastic techniques, tissue expanders are usually necessary for the creation of pockets where the breast implants will later be placed.…”

“… 42 Popular abdominal flaps include the TRAM and DIEP flaps; however, lack of skin laxity and scars to the lower abdomen may prevent their use. 4 , 22 , 43 Other options reported include a vertically-oriented thoracodorsal artery perforator (TDAP) flap, 2 transverse myocutaneous gracilis flap, 44 , 45 and unconventional flap designs given local deformities, such as the one reported by Boehm et al, which combines a tensor fascia lata with ALT flap. 42 …”

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

“…When the breast is affected in total together with surrounding tissues, free tissue transfer might be the only remaining option to achieve an aesthetic reconstruction of the entire breast unit. Cases in the literature were limited with only three reports (Table 1) (Boehm et al, 2018;Tsai et al, 2004;Weitgasser et al, 2018). The common denominator in these were the challenging nature of the burn involving multiple areas and unavailability of local donor sites.…”

“…Weitgasser et al (2018) used bilateral TMGs for the reconstruction of bilateral entire breast subunits. However, their reconstruction was suboptimal as bilateral partial flap necroses occurred with loss of natural shape, projection, and smoothness.…”

Engineering 3D degradable, pliable scaffolds toward adipose tissue regeneration; optimized printability, simulations and surface modification

“…For patients suffering from large adipose tissue defects—for example, after surgical removal of breast tissue, traumatic injury, or severe deep burns—tissue reconstruction remains one of the foremost clinical challenges for plastic and reconstructive surgeons. 1 , 2 There is an increasing demand for adequate medical implants, since these large adipose tissue defects do not regenerate spontaneously and require a high volume of adipose tissue to maintain the shape and restore functionality. 3 The commercially available fillers such as hyaluronan, fibrin, and viscoelastic hylan gels have been used for adipose tissue regeneration.…”