[Surgical treatment of sequelae of deep breast burns: a 25-year experience].
BACKGROUND
Deep chest burns in prepubescent girl prevent the development of the mammary gland, because scar contracture becomes an inextensible envelope. In adults, scar contracture can deform the breast shape. The aim of this work is to define the interest of tissue expansion in breast reconstruction of prepubescent's and adult's post-burns scars.


METHODS
We conducted a 25-year retrospective study including patients treated surgically for deep thoracomammary burns. We studied following parameters: surgical techniques step by step, average time between each intervention, and morphologic and aesthetic results achieved.


RESULTS
Twenty-eight patients have been operated between 1983 and 2008. Each patient has been operated on average 4.5 times (two to 12 times) during 6.3 years on average (1-19 years). Adult patients have showed a higher number of response (5.5 on average) than prepubescent girls (2.4 on average). Number of skin expansion has been 1.2 (0 to three) per patient. Sixty-two expanders have been placed (one to eight), 390cm(3) volume on average (180-1200). Delay of skin expansion has been about 7 months (4-10). Twenty-five breast implants have been raised on average 11 months (6-17) after debridement. Three changes of breast implant have occurred on average 5.3 years after insertion (3-8). Reconstruction of the areolonipple complex and controlateral symetrisation were conducted generally in the same time, 1 year after the last intervention. All patients will receive the possible additional volume (breast implant). Alternatives in breast volume reconstruction are lipomodelling and musculocutaneous expanded flaps. They are also discussed. Breast reconstruction in post-burns scars give clever cosmetic and morphologic despite of breast shape imperfections and apparent scars persistence satisfied cosmetic and morphologic results. These results, analyzed over a period of 25 years, show a qualitative change and decreased postoperative complications.


CONCLUSIONS
Locoregional tissue expansion provide very clever results. In pre-pubescent grils, skin expanded flaps allow a near-normal mammary gland development. In adult women, they make the envelope that will receive the possible additional volume (breast implant). Alternatives in breast volume reconstruction are lipomodelling and musculo-cutaneous expanded flaps. They are also discussed. Breast reconstruction in post-burns scars give clever cosmetic and morphologic despite of breast shape imperfections and apparent scars persistence.
Ho Quoc
C
C
Service de chirurgie plastique réparatrice et esthétique, centre hospitalier Saint-Joseph—Saint-Luc, 20, Quai Claude-Bernard, 69365, Lyon, France.
Bouguila
J
J
Brun
A
A
Voulliaume
D
D
Comparin
J-P
JP
Foyatier
J-L
JL
D000293:Adolescent; D000328:Adult; D001940:Breast / Q000293:injuries* / Q000601:surgery*; D019928:Breast Implantation / Q000379:methods; D002056:Burns / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000379:methods; D016896:Treatment Outcome