855 Reconstruction of Severe Burns to the Breast in Pediatric Patients: A Ten-year Experience

Abstract Introduction The breast and anterior chest are the most commonly burned part of the trunk. Burn injuries to the breast can be associated with pain, asymmetries, and significant social stigma. Burns to the breast bud in the young female may inhibit normal breast development, and result in either significant asymmetries or amastia, making the treatment of breast burn injuries challenging. Methods A retrospective chart review was conducted on all female patients under the age of 21 years admitted to our institution for breast burn injuries from January 1st 2008 – December 30th 2018.This project was undertaken at our institution as an exempt project under 45 CFR 46.101 and, as such, it was not formally supervised by an Institutional Review Board. Patients were included if they had follow-up reconstructive procedures for breast burn injuries many days after their acute phase treatment. Results Ninety-six patients aged 1 to 20 years have been admitted to our institution with burned breast injuries. The mean age of this cohort (n=96) was 6.4 ±4.8 years with a mean percent TBSA of 36.3 ±21.4 and a mean time since injury from admission of 2279.1 ±2284.1 days. Flame burns (66.8%) were the most common etiology for breast burn injuries, followed by scald burns (22.8%), in this cohort. The mean body mass index was 22.7 ±6.3 kg/m2. Follow up for reconstructive procedures was 7.2 ±5.6 years after injury date. Conclusions Our institution’s ten-year experience of 96 female patients with severe burn injuries has enhanced our understanding of reconstructive techniques. The location, size, anatomic extent, type of deformity, and symmetry must all be assessed before any treatment plans, which may need to include a combination of modalities. Applicability of Research to Practice Most importantly, surgeons must preserve viable breast bud tissue during debridement. Scar contractures should be released once there are signs of breast development, and the scar contracture significantly impairs normal breast development. Treatment of these contractures with a combination of release and grafting, local flaps or tissue expansion can reduce breast asymmetry. Reduction mammoplasty may be used safely in burned female patients with minimal risks, if key principles are followed.