Most patients sustained full thickness burn injury (n = 27; 67.5%). The top 3 methods of reconstruction overall were pedicled TRAM (47%), implant or expander (35%), and pedicled latissimus dorsi flap (7%; Fig. 5). Fifteen patients (5 in our group and 10 in the peer-reviewed papers) had information regarding the receipt of radiation; of those, 11 patients had received radiation. Most burns healed by secondary intention (n = 24, 60%), 11 of whom had sustained partial thickness burns (45.8%). The proportion of patients requiring treatment with a surgical procedure was significantly higher in the group that sustained full thickness burns in comparison with partial thickness burns [n = 14, 51.9% (full) versus n = 1, 8.3% (partial); P = 0.0076). Five patients had full or split thickness skin grafts, 6 had removal of the implant or expander (one required a split thickness skin graft in addition), 2 patients required salvage with latissimus dorsi flaps, and 2 had local flaps (local tissue rearrangement).
After breast reconstruction using any available method, patients are vulnerable to thermal injury to their reconstructed breasts, because of loss of sensation.1,20 Although a subset of patients may have partial return of sensation after breast reconstruction, there is still insufficient sensation to provide protection from exposure to commonly utilized household thermal devices such as heating pads and hot water bottles. In addition, patients are not routinely made aware of the perils of these devices on their reconstructed breasts, and it may be helpful to furnish patients with a list of such devices to avoid.
Once a patient has sustained a thermal injury to a reconstructed breast, immediate evaluation and treatment is necessary. Partial thickness burns can often be treated with local wound care and close observation. Full thickness burns are likely to require surgery (either immediately or in a delayed fashion) to remove an exposed implant or expander, and excise a full thickness burn. These patients may require split or full thickness skin grafts or a myocutaneous flap for salvage.
Burn injuries to reconstructed breasts may occur more frequently in colder climates. As such, we have added an item to our postoperative instructions for patients explicitly stating to avoid the use of warming or cooling devices on reconstructed breasts. We counsel patients to avoid direct sun exposure to reconstructed breasts in addition. We have extended these instructions to patients that have undergone free tissue transfer, as these types of injuries have been shown to also occur in patients who have undergone free tissue transfer for reconstruction of other body regions, such as the scalp or extremities.21 Patients should be notified that these risks are not just in the immediate postoperative period, and in fact do last for their lifetime.
1. Lagergren J, Wickman M, Hansson P. Sensation following immediate breast reconstruction with implants. Breast J. 2010;16:633638.
2. Shridharani SM, Magarakis M, Stapleton SM, et al. Breast sensation after breast reconstruction: a systematic review. J Reconstr Microsurg. 2010;26:303310.
3. Unukovych D, Johansson H, Johansson E, et al. Physical therapy after prophylactic mastectomy with breast reconstruction: a prospective randomized study. Breast 2014;23:357363.
4. Snell L, McCarthy C, Klassen A, et al. Clarifying the expectations of patients undergoing implant breast reconstruction: a qualitative study. Plast Reconstr Surg. 2010;126:18251830.
5. Maxwell GP, Tornambe R. Second- and third-degree burns as a complication in breast reconstruction. Ann Plast Surg. 1989;22:386390.
6. Lejour M. Burn of a reconstructed breast. Plast Reconstr Surg. 1996;97:13061307.
7. Alexandrides IJ, Shestak KC, Noone RB. Thermal injuries following TRAM flap breast reconstruction. Ann Plast Surg. 1997;38:335341.
8. Beckenstein MS, Beegle PH, Hartrampf CR Jr. Thermal injury to TRAM flaps: a report of five cases. Plast Reconstr Surg. 1997;99:16061609.
9. Kay AR, McGeorge D. Susceptibility of the insensate reconstructed breast to burn injury. Plast Reconstr Surg. 1997;99:927.
10. Restifo RJ. Heating pad burn of a reconstructed breast. Plast Reconstr Surg. 1997;100:547548.
11. Davison JA, Mercer DM. Accidental burns following subcutaneous mastectomy and reconstruction with a prosthesis. Br J Plast Surg. 1998;51:486.
12. Davison JA. Burns to reconstructed breasts. Ann R Coll Surg Engl. 1999;81:1922.
13. Price RK, Mokbel K, Carpenter R. Hot-water bottle induced thermal injury of the skin overlying Becker’s mammary prosthesis. Breast 1999;8:141142.
14. Agarwal SK, Williams MR. Burn injuries after latissimus dorsi breast reconstruction in a cold climate. Breast 2002;11:270272.
15. Seth R, Lamyman MJ, Athanassopoulos A, et al. Too close for comfort: accidental burn following subcutaneous mastectomy and immediate implant reconstruction. J R Soc Med. 2008;101:3940.
16. Delfino S, Brunetti B, Toto V, et al. Burn after breast reconstruction. Burns 2008;34:873877.
17. Mahajan AL, Chapman TW, Mandalia MR, et al. Sun burn as a consequence of resting reading glasses on a reconstructed breast. J Plast Reconstr Aesthet Surg. 2010;63:e170.
18. Jabir S, Frew Q, Griffiths M, et al. Burn injury to a reconstructed breast via a hot water bottle. J Plast Reconstr Aesthet Surg. 2013;66:e334e335.
19. Gandolfi S, Vaysse C, Garrido I, et al. Burn injury to a reconstructed breast via a cigarette causing implant exposure. The importance of the patient’s education. Breast J. 2014;20:543544.
20. Lagergren J, Edsander-Nord A, Wickman M, et al. Long-term sensibility following nonautologous, immediate breast reconstruction. Breast J. 2007;13:346351.
21. Butler CE, Davidson CJ, Breuing K, et al. Thermal injuries to free flaps: better prevented than treated. Plast Reconstr Surg. 2001;107:809812.