Principles of burn reconstruction: The female breast
- Jorge Leon-Villapalos, MD, FRCS
Jorge Leon-Villapalos, MD, FRCS
- Consultant in Plastic Surgery and Burns
- Chelsea and Westminster Hospital, London, UK
- Peter Dziewulski, MD, FRCS
Peter Dziewulski, MD, FRCS
- Consultant in Plastic Surgery and Burns
- St. Andrews Centre for Plastic Surgery and Burns, Essex, UK
The breast and the nipple-areolar complex are frequently injured in burns involving the anterior chest wall. Burns to the breast can potentially impair and/or destroy both function and esthetics. Damage to the breast is particularly important to the prepubescent young girl. Absence of a nipple is a noticeable and striking concern to both women and men burn patients, even when more extensive burns and scarring are present elsewhere .
The principles of burn reconstruction for the female breast are discussed here. An overview of reconstruction techniques, the local management of burns with topical antimicrobials and dressings, and the acute management of a burn patient are discussed elsewhere. (See "Principles of burn reconstruction: Overview of surgical procedures" and "Local treatment of burns: Topical antimicrobial agents and dressings" and "Emergency care of moderate and severe thermal burns in adults" and "Emergency care of moderate and severe thermal burns in children".)
Most burns to the breast occur in children and in the domestic environment [2,3]. The most common causes of burns to the female breasts include scalds (range 66 to 89 percent), flame (range 8 to 34 percent), cooking oil (range 2 to 5 percent), and other trauma (<5 percent) [2,4]. The epidemiology of the global burden of burns is discussed elsewhere. (See "Epidemiology of burn injuries globally".)
The mammary gland in children is located four to eight millimeters deep into the subcutaneous tissue . Familiarity of the location of the breast tissue in children is mandatory before beginning a debridement procedure to the anterior chest wall (figure 1 and figure 2).
INITIAL TREATMENT AND EARLY MANAGEMENT
Burns to the breast are initially gently washed and debrided of loose burned skin and debris and dressed with topical antimicrobials and dressings. The burn eschar should not be excised from the nipple-areolar complex, but should be allowed to separate spontaneously as healing proceeds from the deep glandular structures [1,5]. The relative avascular adipose tissue and connective tissue of the nonlactating breast requires a careful excision of all nonviable tissue . In prepubertal girls, care should be taken not to excise the breast bud from the anterior chest wall during the debridement of the burned skin . In adult females, the breast mound should not be excised, if at all possible.
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- ANATOMIC CONSIDERATIONS
- INITIAL TREATMENT AND EARLY MANAGEMENT
- PREPUBESCENT FEMALES
- RECONSTRUCTION PRINCIPLES FOR THE DEVELOPING BREAST
- RECONSTRUCTION OF THE ADULT BURNED BREAST
- Restoration of the shape, volume, and skin
- Restoration of the inframammary fold
- Restoration of the nipple-areolar complex
- SPECIAL CIRCUMSTANCES
- Burns during pregnancy and lactation
- Burns to large breasts
- Burns to the reconstructed breast
- Postburn mammary hyperplasia
- SUMMARY AND RECOMMENDATIONS