Abstract
Background
Post-burn breast deformities are not an uncommon condition after severe second-degree or third-degree burn and present as severe asymmetry of the breast as compared to the opposite side, displacement of nipple-areola complex, obliteration of inframammary fold, and reduced breast projection. Based on deformities especially for lower pole breast contracture, we propose a new classification to describe breast contracture. There is no tailor-made approach described to deal such deformities. Various options are available ranging from skin graft to different flaps. We present reconstruction by TDAP flap after the release of breast contracture grades I and II. This study aimed to classify the lower pole breast contracture according to its severity and to evaluate the outcome of TDAP flap reconstruction and augmentation of the lower pole of the breast in terms of symmetry and aesthesis.
Methods
This is a descriptive retrospective study of 10 patients with 15 post-burn contracted breast affecting the inferior pole of the breast and inframammary fold within a period of January 2012 to March 2016 in Kasralainy hospital, Cairo. All cases were evaluated according to flap vascularity, donor site morbidity, symmetry, and esthetic outcome.
Results
All flaps survived completely. Flap dimension ranged from 18 × 10 to 22 × 12 cm. The muscle sparing design had been used in three patients due to lack of reliable perforators. Patients were evaluated for their satisfaction, and all of them were satisfied.
Conclusions
It is essential to classify the grade of post-burn lower pole breast contracture according to the proposed classification. TDAP is a valuable option in case of grade I and II deformities only. For severe grade III breast contracture, more volume restoring procedure is advisable.
Level of Evidence: Level IV, therapeutic study.
Similar content being viewed by others
References
Angrigiani C, Rancati A, Escudero E, Artero G, Gercovich G, Deza EG (2014) Propeller thoracodorsal artery perforator flap for breast reconstruction. Gland Surg 3(3):174–180. https://doi.org/10.3978/j.issn.2227-684X.2014.06.04
El-Otiefy MA, Darwish AM (2011) Post-burn breast deformity: various corrective techniques. Ann Burns Fire Disasters 24(1):42–45
MacLennan SE, Wells MD, Neale HW (2000) Reconstruction of the burned breast. Clin Plast Surg 27:113–119
Angrigiani C, Grilli D, Siebert J (1995) Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 96(7):1608–1614
Spinelli HM, Fink JA, Muzaffar AR (1996) The latissimus dorsi perforator- based fasciocutaneous flap. Ann Plast Surg 37:500–506
Ozgur F, Gokalan I, Mavili E, Erk Y, Keclik A (1992) Reconstruction of postburn breast deformities. Burns 18:504–509
Ozgenel G, Akin S, Kahveci R et al (2002) Reconstruction of burn-damaged female breasts. Eur J Plast Surg 25:152–155
Mueller M, Boorman JG (2002) Post-burn breast resurfacing using an abdominal full-thickness skin graft. Br J Plast Surg 55:148–150
Jarjis RD, Matzen SH (2016) Release and reconstruction of a Postburn deformed breast in a young woman. Plast Reconstr Surg Glob Open 4(3):e643. https://doi.org/10.1097/GOX.0000000000000626.ecollection
Tsoutsos D, Stratigos A, Gravvanis A, Zapandioti P, Kakagia D (2007) Burned breast reconstruction by expanded artificial dermal substitute. J Burn Care & Research 28(3):530–532
Mousavizadeh SM, Motamed S, Hosseini SN, Yavari P (2011) Re-creation of the inframammary fold, breast mound and projection by the latissimus Dorsi musculocutaneous flap in burned breasts. Eplasty 11:e11
Angrigiani C, Rancati A, Escudero E, Artes G (2015) Extended thoracodorsal artery perforator flap for breast reconstruction. Gland Surg 4(6):519–527. https://doi.org/10.3978/j.issn.2227-684X.2015.04.20
Miranda BH, Amin K, Chana JS (2014) The drain game: back drains for latissimus dorsi breast reconstruction. J Plast Reconstr Aesthet Surg 67(2):226–230
Gheita A, Moftah A, Hosny H (2014) Strategies in the management of post-burn breast deformities. Eur J Plast Surg 37:85–94
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Ahmed Ali Ebrahiem and Raj Kumar Manas declare that they have no conflict of interest.
Ethical approval
Not required.
Patient consent
Patients provided written consent for the use of their images.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ebrahiem, A.A., Manas, R.K. Inferior pole breast reconstruction by TDAP flap in post-burn breast contracture. Eur J Plast Surg 42, 337–342 (2019). https://doi.org/10.1007/s00238-019-1504-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-019-1504-x