Reconstruction of Severe Burns to the Breast in Pediatric Patients: A 10-Year Experience

Abstract

The breast and anterior chest are the most commonly burned part of the trunk. Burn injuries to the breast can be associated with pain, asymmetries, and significant social stigma. Burns to the breast bud in the young female may inhibit normal breast development and result in either significant asymmetries or amastia, making the treatment of breast burn injuries challenging. A retrospective chart review was conducted on all female patients under the age of 21 years admitted to our institution for breast burn injuries from January 1, 2008 to December 30, 2018. Patients were included if they had follow-up reconstructive procedures for breast burn injuries many days after their acute-phase treatment. Ninety-six patients aged 1 to 20 years have been admitted to our institution with burned breast injuries. The mean age of this cohort (n = 96) was 6.4 ± 4.8 years with a mean percent TBSA of 36.3 ± 21.4 and a mean time since injury from admission of 2279.1 ± 2284.1 days. Flame burns (66.8 percent) were the most common etiology for breast burn injuries, followed by scald burns (22.8 percent), in this cohort. The mean body mass index was 22.7 ± 6.3 kg/m2. Follow-up for reconstructive procedures was 7.2 ± 5.6 years after injury date. Our institution’s 10-year experience of 96 female patients with severe burn injuries has enhanced our understanding of reconstructive techniques. The location, size, anatomic extent, type of deformity, and symmetry must all be assessed before any treatment plans, which may need to include a combination of modalities.

Postburn breast reconstruction: a scoping review

“…Furthermore, as the breast bud is hidden deep into the subcutaneous tissue, breast mound development may ensue later in puberty even in the absence of the NAC. 1,4,5,10,[13][14][15][16][17] As sheet grafts contract less than meshed grafts and result in better skin texture, they are preferred in the acute care setting. 18,19 When scars are limited to the skin and the breast bud is spared, the pubertal breast parenchyma will develop underneath a contracted skin envelope, leading to deformity.…”

“…While we found that thermal injury occurred before or during puberty in approximately 53% of the cases reported in the literature, Sadeq et al noted that 83% of their 96-patient cohort sustained burn injury in the prepubescent period. 10 Pediatric scald injuries to the chest typically affect the skin only; however, deep scalds and flame injuries may involve the breast bud, which is located beneath the NAC. 4 In such instances, conservative acute treatment of the burned NAC is recommended because of its remarkable ability to regenerate from the epithelium of the lactiferous ducts.…”

“…Furthermore, as the breast bud is hidden deep into the subcutaneous tissue, breast mound development may ensue later in puberty even in the absence of the NAC. 1 , 4 , 5 , 10 , 13 – 17 As sheet grafts contract less than meshed grafts and result in better skin texture, they are preferred in the acute care setting. 18 , 19 …”

“…Nonetheless, tissue expanders have been suggested to act as internal compression devices, possibly adding benefit as scars softeners. 10 , 17 , 19 , 31 , 43 , 46 – 48 In patients with thick scar tissue that prevents the expander to fully inflate, radial stellate-shaped incisional contracture release to the breast mound has been reported to be effective. 49 Endoscopic alloplastic techniques have reportedly shown lower incidence of complications, which is likely associated with the remote placement of incisions.…”

Predictors of adolescents’ response to Young Person’s Face IT: A web-based intervention to improve psychosocial adjustment to having an appearance-affecting condition (Preprint)

“…Biomedical procedures may include reconstructive or aesthetic surgery . The benefit of reconstructive surgery is its potential to improve functional outcomes and prevent later complications (Piper et al, 2016;Sadeq et al, 2020), whereas cosmetic and aesthetic surgery may be more strongly dictated by psychosocial motivators. For example, stigmatising experiences may be the main motivator of undergoing aesthetic surgery, and such surgery may contribute to the reduction of experiences of teasing and bullying (Johns et al, 2017;Jones et al, 2020) or improve health-related quality of life (Jones et al, 2020).…”