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      Reconstrucción de secuela cicatricial postquemadura con colgajo excedente de abdominoplastia inversa Translated title: Reconstruction of post-burn scar sequel with excess flap of reverse abdominoplasty

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          Abstract

          Resumen Las secuelas de quemadura en la región tóraco-mamaria producidas en la niñez pueden causar cicatrices patológicas y retracciones debido a su difícil cicatrización. Su reconstrucción es parte fundamental del tratamiento para mejorar la estética corporal, el bienestar psicosocial y la calidad de vida en estos pacientes. Presentamos el caso clínico de una mujer de 42 años con secuela por placa cicatricial en hipocondrio izquierdo y glándula mamaria derecha con retracción, producida en la infancia por quemadura por fuego directo, resuelta con colgajo de abdominoplastia inversa que permitió buena cobertura, eliminación de defecto y formación de surco inframario con aumento de volumen del polo inferior de la mama y resultados estéticos satisfactorios.

          Translated abstract

          Abstract Burn sequels in the thorax and mammary region produced in childhood can cause pathological scars and retractions due to difficult scaring. Reconstruction is a fundamental part of treatment to improve body aesthe- tics, psychosocial aspects and quality of life in patients. We present a case report of a 42 year-old woman with scarring plaque in left hypochondria and right mammary gland with retraction, produced in childhood by burning with direct fire, solved with reverse abdominoplasty flap which allowed good coverage, elimination of the defect and creation of the inframary groove with increased volu- me of the lower pole of the breast and satisfactory aesthetic results.

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          The evolution of breast reconstruction: a historical perspective.

          Plastic surgeons have been performing operations to improve the aesthetic aspect of the breast for centuries. Throughout ancient times, great controversy produced many theories of how breast cancer occurred and the best treatment. Because of beliefs that closure of mastectomy sites could conceal tumor recurrence, breast reconstruction did not gain wide acceptance until the mid-1900s. Today, plastic surgeons have a variety of techniques to reconstruct the breast. The first autologous muscle flap for breast reconstruction was the latissimus dorsi myocutaneous flap, described in 1896 by Iginio Tansini. The introduction of Carl Hartrampf's transverse rectus abdominis myocutaneous flap and Robert J. Allen's deep inferior epigastric perforator flap have also provided excellent reconstructive options. With regard to augmentation, Vincenz Czerny attempted to enhance a woman's breast in 1895 with implantation of a lumbar lipoma. Soon after, surgeons used paraffin injections and polyvinylic alcohol sponge implantation, which yielded disastrous results. In 1961, Thomas Cronin and Frank Gerow promoted the first silicone implant, paving the way for today's silicone and saline prototypes. Although reduction mammaplasty techniques had originated centuries earlier than mastopexy methods, the advancements of both have largely paralleled one another. In 1949, the Wise pattern was introduced to preoperatively plan safer and predictable outcomes in breast reductions. Efforts to minimize scars were achieved with Claude Lassus' introduction and Madeleine Lejour's subsequent modification of the vertical scar mammaplasty. In hopes of fostering an understanding of current post-mastectomy procedures and instilling passion for innovating future techniques, we provide a near-complete, surgically focused historical account of the primary contributors to breast reconstruction.
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            Reverse Abdominoplasty: A Practical Option for Oncological Trunk Reconstruction

            Objectives: Following radical oncological resection, full-thickness upper central trunk defects present a significant challenge. Common reconstructive options include pedicled flaps, such as pectoralis major, rectus abdominis, and latissimus dorsi. In complex cases, free tissue transfer may be required. Reverse abdominoplasty, although initially described for cosmetic body contouring, can be used to reconstruct upper central trunk defects following radical tumour ablation. We present 4 such applications in the management of advanced or recurrent malignancies and review the relative indications for this approach. Methods: Four consecutive cases (2004-2010) were reviewed with respect to indication, operative procedure, and complications. Results: There were no cases of complete flap loss. One patient underwent revision for marginal flap necrosis while another developed local recurrence, requiring re-excision and reconstruction with flap advancement. Conclusions: Where pedicled flaps are unavailable or insufficient, adjacent abdominal tissue can be recruited into chest wall defects, avoiding microsurgical free tissue transfer. The authors feel that the reverse abdominoplasty is currently underused in this context and offers an excellent alternative in complex cases where other reconstructive options are unavailable, or where comorbidities preclude free-tissue transfer. The technique is versatile, simple to perform and affords an acceptable cosmetic outcome, yet is not widely reported in the literature. It has particular merit in cases with a high chance of disease recurrence, in the management of recurrent breast cancer, and in patients with multiple comorbidities. The reverse abdominoplasty should therefore be considered when evaluating patients for oncological trunk reconstruction.
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              Custom-made approach to a patient with post-burn breast deformity

              Second and third degree burns on breasts at preadolescent period may cause severe breast deformations. This deformation can be variable depending on severity and location of the burns, personal adolescent patterns, and treatment modality in acute burn period. A 21 year old female patient admitted to our department for her breast deformation due to burn contracture at the inferior pole of the right breast. On physical examination we defined that development of the volume of the right breast was equal to the left, and inferior pole of the right breast was flattened due to contracture, and nipple was projected to inferior. We found that inframammary crease of the right breast was 2 cm lower than that of left; andthe distance of nipple-inframamary crease was 4.7 cm while areola-inframmary crease was 2 cm. New nipple-areola complex level was identified according to left breast's level. Medial and lateral lines were planned to merge inferiorly at 2 cm above inframmary crease in a plan similar to vertical mammaplasty. Superior pedicle carrying nipple areola was desepitelised. Lower parenchymal V flap was transposed superiorly and attached to the pectoral muscle. Inferior parts of the lateral and medial glandular flaps were excised to form new inframammary crease. The desired laxity of skin at the lower pole was obtained by performing a new Z- plasty between lateral and medial skin flaps. Breast symmetry was confirmed by postoperative objective measurements between left and right breasts. Patient's satisfaction and aesthetic appearance levels were high. Breasts deformation patterns caused by burns, trauma and mass exsicion due to cancer could not be addressed with traditional defined techniques. Special deformations can be corrected by custom made plannings as we presented here.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                June 2022
                : 48
                : 2
                : 227-232
                Affiliations
                [2] orgnameHospital Clínica San Agustín orgdiv1Servicio de Cirugía Plástica, Reconstructiva y Estética
                [1] orgnameHospital Clínica San Agustín orgdiv1Servicio de Cirugía Plástica, Reconstructiva y Estética
                Article
                S0376-78922022000200227 S0376-7892(22)04800200227
                10.4321/s0376-78922022000200014
                e3746291-1c07-4cbf-8ce6-68dc9f5c3e89

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 20 May 2022
                : 19 March 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 6
                Product

                SciELO Spain

                Categories
                Quemados

                Abdominoplastia inversa,Post-burn sequel,Post-burn scar,Inverse abdominoplasty,Secuelas quemaduras,Cicatriz postquemadura

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