[Reconstruction of breast burn sequelae in young girls through tissue expansion starting in the prepubertal phase]

Burns on the thorax are common in children. When these burns are deep and extensive in girls, they pose a risk of aesthetic and functional sequelae due to impaired breast growth. The management of these sequelae can be initiated as early as the prepubertal phase, with an initial stage involving the replacement of the scarred skin with healthy skin by using tissue expansion.

We present our protocol for skin resurfacing of the breast areas through tissue expansion initiated in the prepubertal stage. We describe the indications (related to the patient, related to their burn, and other associated burns). We detail the preoperative planning and the operative technique, including the placement of expanders and the type of flap used. We illustrate this with clinical cases.

Between January 2018 and December 2023, six patients were followed in a multidisciplinary consultation for thoracic burn sequelae. Their initial burn occurred at an average age of 4.6 years, with the affected body surface ranging from 15 to 31%. All underwent early skin grafting. The sequelae affected at least two quadrants, involving both breasts in all cases. Treatment with tissue expansion began at an average age of 8.6 years, with one to three protocols per patient. A total of 24 expansion implants were placed, sometimes combined with other reconstructive surgeries. These were primarily placed in the supramammary region to position scars in the inframammary folds, and advancement flaps were used whenever possible to reduce scarred skin surface. Complications included prostheses protrusion without exposition, skin necrosis, and limited surgical revisions. All patients were able to complete their treatment without major therapeutic failure.

Skin resurfacing of burned breast areas through tissue expansion before breast development offers many advantages. It allows either the natural growth of an undamaged gland or the gradual reconstruction of breast volume during puberty. This therapeutic strategy, when used under appropriate indications, helps to reduce the early aesthetic and psychological impact of breast burn sequelae in young girls.