الفهرس 
ANATOMY OF THE BREASTOnly 14 pages are availabe for public view
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Abstract
urns of the front of the chest and abdomen and
sometimes the front of the neck and axilla, mostly
done in domestic accidents and are very common in Egypt.
Following resuscitation and stabilization, management
of the burn wounds becomes the next priority. The goals of
reconstructive surgery for the burn patient are first to restore
function, then to restore aesthetic appearances. The later effects
of burns, which are related to loss of normal tissue and
scarring, include limitation of movement, pain, disfigurement,
and social embarrassment.
In acute management of burns to the breast; the burn
eschar should not be excised from the nipple areola complex,
but should be allowed to separate spontaneously as healing
proceeds from the deep glandular structures. The key to longerterm
local burn care is scar management, which can be
achieved through surgery and physical therapy.
For burns to the breast during pregnancy, it is important
to note that pregnancy, by itself, does not alter maternal
outcome in burn injuries, and foetal and maternal survival
correlate with the total body surface area burned.
B
Summary
-172-
It is suggested to use split-thickness skin grafts to
reconstruct the burned anterior chest wall in young girls and
prefer to delay reconstruction with flaps and release of
contractures until after breast development.
The reconstruction in the fully developed breast needs to
take into consideration the restoration of nipple height, the
adequate definition of the inframammary fold and the
symmetry in volume, size, and shape of both breasts. It is
suggested to use autologous tissue, either as a free or pedicled
flap (with or without prosthesis insertion) to provide the
optimal cosmetic result for restoring volume and shape.
Various options are available for breast reconstruction with
autologous tissue. These include the free transverse rectus
abdominis myocutaneous (TRAM) flap, deep inferior
epigastric perforator flap, superficial inferior epigastric artery
flap, superior gluteal artery perforator flap, and
transverse/vertical upper gracilis flap. In addition, pedicled
flaps can be very successful in the right hands and the right
patient, such as the pedicled TRAM flap, latissimus dorsi flap,
and thoracodorsal artery perforator. A tissue expander or
implant can be used to enhance the results if the autologous
tissue is insufficient.
Asymmetry is best addressed by performing a breast
reduction of the larger breast in cases of a unilateral burn and
impaired breast development. Reduction mammoplasty can
also be done in postburn deformities of the large both breasts .
Summary
-173-
A second staged procedure to reconstruct the nipple
papilla should follow breast volume and shape restoration.
Local tissue is typically used to form the papilla. Once the scar
is mature, tattooing provides an excellent option to enhance the
appearance of the nipple areola complex .
The ultimate goal of burn care, beyond survival and
functional restoration, is to restore the quality of life and the
potential for productive lives. It is also clear that exercise after
hospital discharge is critically important for facilitating physical
functional and metabolic recovery following a major burn
injury.
Scientific advances in treating acute burns have led to a
marked increase in the number of victims surviving massive
burns. As the number of females living with burns has
increased, so too has concern for the psychosocial outcomes
and interest in action to enhance quality of life for burned
female.