Adolescent Burned Breast Reconstruction
David A. Billmire
Kim A. Bjorklund
Burned breast contractures and loss are a common occurrence in females who sustain major burns injuries prior to adolescence.
Knowledge of the importance of preserving the breast bud in preadolescent females has lessened the need for complete reconstruction.1,4
In the acute burn phase, debridement should be kept to a minimum in the area of the nipple areolar area.2
With the onset of puberty, the breast bud will begin to grow and expand the overlying skin acting much like a tissue expander.4
Any overlying scar can cause restriction and/or distortion of the maturing breast mound.
Additionally, full-thickness tissue loss from the burn injury surrounding the breast bud will cause additional loss in the eventual volume of the breast.
Complete loss of the breast bud itself will result in a smaller or absent breast.
Burn wounds may also result in the loss of the nipple areolar complex, despite the development of an acceptable breast mound.
Full-thickness and deep second-degree burn injuries to the female chest warrant special care in the acute burn wound and careful management in the subsequent time period prior to development of the breast.3,4,5
Care should be taken with axillary releases, especially when considering the use of Z-plasties. An inappropriately designed Z-plasty can unknowingly transpose the breast bud into the axilla.
As the breast develops, the amount of constriction and distortion will become apparent.
It is advisable to delay release/reconstruction until the breast has reached its full size.
Rarely, the release may be warranted prior to growth completion and will most likely need to be repeated.
PATIENT HISTORY AND PHYSICAL FINDINGS
Long-term follow-up for young females with significant chest burns is critical to identify any problems during adolescence.4
Once the breast has begun developing, the patient should be evaluated about every 6 months to assess potential problems.
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