Post-burn breast deformity: various corrective techniques

Burns of the front of the chest and abdomen and sometimes the front of the neck and axilla, mostly caused by flame in domestic accidents, are very common in Egypt. If deep, these burns can produce breast deformity in females either in childhood or in adolescence. This work considers 74 female breasts in 55 patients who had post-burn breast deformities due to accidents in childhood or early adulthood. The patients' median age was 21 years (range, 13 to 42 years). The cause was scalding in 18 patients and flame in 37. The following conditions were found: upward contracture in 26 breasts (35%), 21 patients; downward contracture in 32 breasts (43%), 25 patients; and loss or distortion of the nipple/areola complex in 16 breasts (22%), 9 patients. Surgical correction included: Z-plasty, scar revision, scar excision and reconstruction by local flap or skin graft, and use of tissue expanders. Adequate projection of the reconstructed breast with the creation of a normal-looking inframammary fold was obtained. There were no major complications. Two patients had partial skin loss of the split-thickness graft, and partial loss of edges of the areola occurred in three cases. The burns thus caused various degrees of breast deformity and the corrective surgery varied accordingly. It is concluded that in such cases the general rules of scar revision have to be applied, correcting the contracture by Z-plasty or else by a local flap, if available, or by a split-thickness graft if the surrounding area is affected by post-burn scarring or if a large defect appears after complete release. Tissue expanders play a role in some if the scar area is surrounded by normal healthy tissue.