Breast Burns Scar Reconstruction: A Systematic Review of Management Considerations and Recommendations.

Abstract

Breast burns scar reconstruction presents a unique challenge to the plastic surgeon. The consensus view and evidence base for the optimum reconstructive approach to take is not yet established in the literature. This study aims to review the literature to ascertain evidence-based principles for management of this patient cohort. A literature search of Medline was performed using the mesh terms: "breast burns", "chest burns", "reconstruction" and "surgery". Screening was performed by two independent assessors, with a senior assessor to resolve discrepancies. Expert articles, reviews, individual case reports and letters were excluded. Literature search generated 1,385 publications. Of these, 22 were deemed eligible for inclusion in this review. These encompassed 483 patients. We present the operative considerations, surgical technique used and outcomes. The recommendations from included literature were summarised to guide the surgeon when approaching breast burns. These include tangential excision, breast bud preservation, scar release at onset of thelarche, and reconstruction only once breast development has completed. Reconstructive approaches and their indications vary with burn severity, status of abdominal and back tissue, and unilateral or bilateral burn injury. The literature on breast burns reconstruction defines certain key steps for management. There is limited quantitative data on the various reconstructive options and lack of long term follow up data. Further work is needed to establish if a particular surgical approach leads to superior results when compared with others.