Abstract Burns of the anterior chest can cause signifi-
cant distortion of the developing breast. The skin, nipple–
areola complex and breast tissue can be injured to a vari-
able degree, leading to abnormal breast development.
Reconstruction of the burned breast becomes necessary
when the overlying burn scars cause restriction of nor-
mal breast growth and development. The use of tissue
expansion in the reconstruction of the burned breast pro-
vides an alternative to traditional methods. Two clinical
cases of breast burn scar reconstruction in young girls
using tissue expansion are reported; in one case this was
combined with an atypical reduction mammaplasty.
Keywords Burned breast · Tissue expansion · Timing of
Deep burns of the breast can cause serious developmen-
tal, aesthetic, and psychological problems. In the acute
management, early tangential excision is modified when
dealing with chest wall burns in young female patients.
The surgeon must be extremely conservative in debrid-
ing the nipple area; this should only be performed after
nonviable tissue becomes clearly demarcated .
The main problem following a breast burn is contrac-
tion of the burn and skin graft scars; this can impede nor-
mal development of any viable breast tissue . Scar-
ring, deformity, and asymmetry are major indications for
post-burn breast reconstruction; this should be done after
puberty and scar maturity are reached .
In 1976, Radovan introduced the concept of tissue ex-
pansion by gradual inflation of an implanted prosthesis
. In the 1980s, tissue expansion was applied to burn
reconstruction, especially in head, neck, and trunk. Sev-
eral authors have reported breast burn reconstruction
with tissue expansion [2,4], but that technique is not very
popular in this region. We present our experience, albeit
limited, in dealing with this problem.
A 16-year-old female presented with deformities of both breasts
resulting from deep thermal burns at the age of 4. The left arm and
the anterior and posterior trunk were involved, being 25% of total
body surface area. She complained of breast pain and was psycho-
logically distressed by the deformities. The breasts were hypoplas-
tic and flattened, with retractile scars covering the entire surface,
except in a small area at the upper pole (Fig. 1a). The nipple–
areola complexes were symmetrical.
Through incisions in the upper pole of the gland, two round
shaped tissue expanders of 600 cc, with remote external valves,
were placed in the supra-mammary regions. Expansion was com-
menced 2 weeks postoperatively and continued at weekly inter-
vals. This lasted for a period of 3 months. There were no compli-
cations and there was minimum patient discomfort. The total ex-
pansion was: 780 cc on the right and 700 cc on the left (Fig. 1b).
At this stage, the expansion was considered to be complete, and
removal of the expanders was planned.
The nipple-areola complexes were marked, and the expanders
were removed through incisions in the region of the transition of
breast scar tissue to normal expanded skin. The retractile scars
were excised just to the inframammary fold, and the extremity of
each pre-expanded advancement flap was anchored to it. Horizon-
tal incisions 3 cm in length were made in the middle part of each
flap, in the location of the native nipples, allowing the native nip-
ple-areola complexes to be preserved. Postoperatively, there was
significant improvement in the breast shape and size, consequently
providing a satisfactory aesthetic result (Fig. 1c–e.
An 18-year-old female sustained deep thermal burns at the age
of 4. The areas involved were the shoulder, the axilla, and the an-
terior lateral chest regions. At the age of 8, a Z-plasty was per-
formed to release a tight scar in the axillary region; at the age of
11, a staged serial excision of the scars in the shoulder region was
E. Monteiro (
R. Marta Mesquita da Câmara 149 Hab:31, 4150 Porto, Portugal
E. Monteiro · M. Maia · J. Guimarães · A. Moura · P. Carvalho
P. Costa · A. Ferraro
Department of Plastic, Reconstructive and Aesthetic Surgery,
Hospital da Prelada, Porto, Portugal
Eur J Plast Surg (2002) 24:366–369
IDEAS AND INNOVATIONS
E. Monteiro · M. Maia · J. Guimarães · A. Moura
P. Carvalho · P. Costa · A. Ferraro
Tissue expansion in reconstruction of the burned breast
Received: 5 June 2001 / Accepted: 6 August 2001 / Published online: 21 December 2001
© Springer-Verlag 2001