E. McIntyre1, D. Chen1, H. M. Zhang1, K. B. Nguyen1, T. M. Ngo1, C. Goswami1, B. J. Maheta1, A. Noon2, C. Limanon3, M. S. Wong1 1California Northstate University, College Of Medicine, Elk Grove, CA, USA 2Geisinger Medical Center, Department Of Plastic Surgery, Mechanicsville, PA, USA 3Sacramento Community Clinic, Sacramento, CA, USA
Introduction: Thermal injury to the anterior chest wall not only causes physical and emotional trauma, but also leaves survivors grappling with disfigurement, lack of physiologic function, such as breastfeeding, and impaired quality of life. This review evaluates possible breast reconstruction options for patients following thermal injury by comparing the aesthetic outcomes, complications, and functionality through breastfeeding ability.
Methods: PubMed, EMBASE, and Scopus were used in an unrestricted search for postburn breast reconstruction cases. 5,934 articles were screened through an independent and blinded dual review to ensure they included patients with at least one breast affected by burns, provided details about breast reconstruction surgery, and reported postoperative outcomes. Articles were further analyzed for patient and burn characteristics, reconstruction specifications, and the effectiveness of breast reconstruction procedures in retaining breastfeeding ability. Registered on PROSPERO: CRD42023437347.
Results: There were 50 articles with a low risk of bias, analyzing 505 female patients with a history of chest burns. 32 of these studies utilized either local, regional, or distant autologous flaps from various donor sites, including Z-plasties, TDAPs, and TRAMs, with 16 reported satisfactory cosmetic results. 24 of the 50 articles described reconstruction using full- or split-thickness skin grafts, with 12 reporting patient satisfaction. 21 studies described implant-based breast reconstruction, with 13 studies reporting high patient satisfaction and 1 study reporting low patient satisfaction. 3 studies included the ability to breastfeed or breastfeed comfortably as an outcome and 2 patients with minimal damage to the nipple who received skin grafts retained breastfeeding ability.
Conclusion: This review highlights how breast reconstruction following thermal injury requires careful consideration of affected anatomic structures. The level of destruction or alteration of important anatomic structures such as the nipple were key in determining future breastfeeding ability. The majority of included articles reported outcomes on satisfaction and aesthetics. Future articles may consider reporting breastfeeding outcomes such as the ability to lactate or breastfeed without discomfort. In particular, studies can consider the breastfeeding ability of patients who were actively breastfeeding at the time of thermal injury or postpartum mothers after reconstruction surgery. This review provides physicians with a collective evaluation of the breast reconstruction options after chest burns and their differences in outcomes and potential effectiveness of retaining breast contour, nipple sensitivity, and ability to breastfeed.
