Bilateral pressure sores of the breasts—prevention
is better than cure
Muhammad Ali Hussain
Received: 19 November 2010 / Accepted: 7 March 2011 / Published online: 24 May 2011
Pressure-induced ulcers are normally present in non-
ambulant patients over bony prominences subjected to
sustained pressure. They are classified into four types
depending upon their depth and involvement of the fascia.
Anatomical distribution of pressure sores differ between
chronically bed-bound and paraplegic patients depending
on variation in pressure distribution. The commonest region
involved in a supine position is the sacrum and in the sitting
position it is the ischium. Other infrequent areas are the
occiput, upper shoulder, back of calf and cheek. The breast
or side of the chest wall is one of the least frequent areas
involved. We present the first ever case report of pressure
ulceration of large pendulous breasts overhanging onto the
bedside. Both breasts were sensate but gravitationally
dependent with prolonged contact with the bedside.
A 61-year-old morbidly obese female who was previously
ambulant was admitted under the renal physicians with
worsening renal failure. She had a past medical history of
type 2 diabetes, hypertension and end-stage renal failure.
Due to her unstable medical status and morbid obesity, she
was not mobilised throughout her admission.
After 6 weeks of hospital stay, she was referred to us
with large ulcers on the lateral aspects of both of her
breasts. These were initially small but rapidly increased in
size followed by sloughing off of the skin and subcutaneous
tissue with eventual progression to complete necrosis of the
inferio-lateral poles of both breasts.
On examination of both breasts, there were large
bilateral ulcers on the lateral aspect of both breasts. They
measured approximately 12 cm×10 cm on the left breast
and 12 cm×14 cm on the right breast located on the lower
half of the breasts with a necrotic base but sparing the
nipple areolar complex. There was granulation at the edges
with no discharge or cellulitis.
In both breasts, the inframammary fold was spared and
the ulcer involved the dependent portions of the breast. This
is clearly shown in Figs. 1 and 2.
Locally, the bilateral pressure sores of the breast were
debrided and treated with daily granuflex dressings. The
ulcers could not be staged as they had necrotic eschar
making it difficult to judge the depth of the fascia. Due to
significant co-morbidity and the worsening renal failure, the
patient died during her rehabilitation.
This report testifies the importance of careful vigilance
of ‘non-bony’ areas in patients who are non-ambulant,
especially the morbidly obese.
Fig. 1 Right breast
M. A. Hussain (*)
Barts and the London NHS trust. Royal London Hospital,
E1 1BB, London, UK
Eur J Plast Surg (2012) 35:833–834