Re-creation of the Inframammary Fold, Breast Mound, and Projection by the Latissimus Dorsi Musculocutaneous Flap in Burned Breasts

OBJECTIVE Some of the most difficult problems to solve in a postburn breast are the correction of the breast mound deficiency, contour, and projection deformity, which are often associated with an anterior trunk scar. The aim of this study was to describe our experiences of postburn breast reconstruction by the island latissimus dorsi musculocutaneous flap (LDMCF). METHOD Operative procedures were planned after measuring the volume, dimensions, sternal notch-to-nipple distance, deviation, asymmetry, contour, and projection. Scar contracture release was carried out and complete muscle elevation was performed in all patients. The size of the skin paddle depended on the envelope deficiency. Afterward, LDMCF was transferred by a subcutaneous tunneling, and the muscle was sutured in retroglandular, inferomedial, and inferolateral ways to shape the inframammary fold (IMF) contour, breast mound, and projection. The skin of the flap was trimmed to match the envelope deficiency. RESULT A total of 9 burned patients (11 breasts), who had burnt anterior trunks due to scalds and flame, entered the study. They were reconstructed by LDMCF. The patients achieved breast contour (re-creating the IMF), projection, and breast mound increase. The means of breast mound and projection increase were about 140 mL and 2.5 cm, respectively. CONCLUSIONS This study demonstrates that the method used for reconstructing the burned breast depends on the patient's clinical presentation. For the patients with anterior trunk scar who have breast mound deficiency, IMF, and projection deformity, LDMCF is one of the best options of reconstruction.