A Literature Review of Burns in Reconstructed Breasts After Mastectomy

Marie Jaeger, MD; Yonathan Wagman, MD; Alon Liran, MD; Moti Harats, MD; Eyal Winkler, MD; Josef Haik, MD; Ariel Tessone, MD

Disclosures

Wounds. 2016;28(12):422-428. 

In This Article

Abstract and Introduction

Abstract

Objective. The goal of this literature review is to review and combine case studies of accidental burns to the breast, following mastectomy and immediate breast reconstruction with autologous tissue, implants, or tissue expanders.

Methods. The authors searched PubMed and Cochrane Library and reviewed cases of burns of reconstructed breasts after mastectomy from July 1985 to May 2015. Only studies in the English language were included in their search. They also report 5 new cases of burns in patients with burns to the breast, which were either reconstructed with implants or tissue expanders at Sheba Medical Center (Ramat Gan, Israel).

Results. The authors found 21 publications regarding burns after breast reconstruction dating from 1985 to 2014, which equaled 59 cases of reported burns in the 21 included publications. The most common causes of burns were due to heat conduction (37/59) followed by solar radiation (19/59) and heat convection (3/59). The majority of the cases were treated by a conservative approach. The 5 new cases added were all due to thermal radiation (5/5). Two of these cases were treated conservatively (2/5), and 3 underwent surgery (3/5).

Conclusion. The removal of thermoregulatory capabilities of the skin and the thickness of the remaining tissue in the mastectomy procedure are key to understanding the cause of burns to reconstructed breasts.

Introduction

Over the past decade, the leading breast reconstruction modality has shifted from autologous tissue to implant-based techniques.[1] As of 2010, 83% of breast reconstructions in the United States were performed with devices either in 1 or 2 stages.[2] In 2014, 102 215 women in the United States underwent breast reconstruction surgery following mastectomy procedures, which is a 30% increase since 2000.[3] There has also been a significant expansion in implant use.[4] In recent years, several cases of partial- and full-thickness accidental burns of the breast after reconstruction have been documented.[5,6] Although thermal injuries subsequent to reconstruction procedures are rare, they are recognized in the medical community. Most importantly, the burns may have been prevented by properly informing the patient regarding the ease of thermal damage to the tissue of the newly reconstructed breast.

In a literature review by Delfino et al,[7] 38 cases of burns to reconstructed breasts were included. In their review, the majority of cases followed autologous tissue transfer, while only 4 reported cases followed expander-implant breast reconstruction. In addition, their literature search indicates that second- and third-degree burns of the breast skin seem to occur more often after transverse rectus abdominis musculocutaneous (TRAM) flap reconstructions (76% of the reported cases in the literature). Most importantly, they found no reported cases of burns in the skin of nonreconstructed breasts after mastectomy. This review by Delfino et al[7] highly suggests a link between the increased susceptibility to thermal injury of the breast tissue following the reconstruction procedure.

Since nearly a decade has passed since the last literature search on the subject was performed, the authors aimed to update the community on the latest reported cases. In addition, they report 5 new cases of patients who have returned to their medical center after an accidental burn on a previously implanted breast.

Together with this case series, the literature suggests the most common heat sources responsible for the identified burns included:

  1. Heat conduction: using heating pads, hot liquids, and hyperthermia devices.

  2. Solar radiation: sunbathing with a dark swimsuit or using a sun lamp.

  3. Heat convection: using hair dryers.

In the following sections, the authors review the literature, include their case studies, discuss probable causes, and suggest future studies to better understand the origin of these serious yet preventable thermal injuries.

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