Lastly, some of the fat transplanted into the breast tissue area may die off, resulting in necrosis and a number of undesired side effects.
Regenerative Medicine Strategies to Treat Breasts of Burn Victims
Using regenerative medicine strategies to treat burned breast poses several clinical problems. Scarring of the breast can adversely affect the development, contour, and positioning of the breast as well as the cosmetic appearance of the surface of the skin. Traditional treatment involves contracture release and thick split-thickness skin grafting techniques. However, an alternative approach employs dermal regeneration templates for breast reconstruction. One study involved patients who had suffered anterior chest wall burns during childhood. After scar contractures were removed, unmeshed Integra was applied to the wound. Integra is a collagen glycosaminoglycan dermal matrix covered with an outer silicone layer. One month after treatment, naturally-formed collagen fibers were observed in the dermal regeneration template.
By one year, the host collagen had completely replaced the Integra matrix. The elastic fibers were evident throughout the neodermis of the patients. All patients had consistent improvements in breast contour and shape. Clinically relevant recontracture of the graft site did not occur postoperatively. The patients were very satisfied with the outcome of the reconstructive surgery. Grafting with Integra provided an effective and well-tolerated alternative to thick-split thickness grafting for breast reconstruction. Now the biocompatible material is available in unlimited quantity. The special biomaterial can be molded to the particular wound site in the patient without a need for a deep donor site wound or potential for infection, permanent pigment changes, or scarring.
Adipose Tissue-Derived Cells Regenerative Medicine Strategies for the Breast
Ideally, breast reconstruction is performed with the patient’s own fat and skin. Most current techniques for autogenous reconstruction make use of myocutaneous flaps. Skin and fat can also be transferred from the lower abdomen without sacrificing muscle. These flaps are based on one, two, or three perforators of the deep inferior epigastric vessels. The technique has all the direct advantages of the free TRAM flap with decreased possibility of ventral hernia or muscle weakness.
Existing Breast Reconstruction Strategies
Tissue expansion. Breast reconstruction is commonly performed using a temporary tissue expander, which expands the breast skin and chest muscle. A breast tissue expansion device is an inflatable breast implant designed to expand and stretch the skin and muscle to make additional space for a permanent breast implant. A few months after inserting the expander, it is removed and the patient receives either microvascular flap reconstruction or a permanent breast implant.
Latissimus dorsi myocutaneous flap surgery. The latissimus dorsi myocutaneous flap (LDMF) is considered one of the more reliable and versatile flaps used in breast reconstruction. LDMF has several advantages, including the availability of a large volume of tissue. The long vascular pedicle offers a superior range for pedicled flaps. The high caliber pedicle makes free flap vascular anastomoses technically more feasible, even in patients who have significant atherosclerotic disease. There is minimal donor site morbidity. The LDMF is used to provide a sensate reconstruction when it is transferred with an intact neurovascular bundle. The LDMF does not compromise the use of other regional flaps, which can then be used in secondary reconstruction if needed.
Transverse rectus abdominis myocutaneous flap surgery. The transverse rectus abdominis myocutaneous (TRAM) flap surgery is no longer the surgical procedure of choice among reconstructive surgeons because of the risk of hernia and abdominal bulge. In addition, there is a limit of lifting anything over 20 pounds postoperatively. In TRAM flap surgery, fat, muscle, and skin tissue remain attached to the original donor site and vascular supply. The tissue is tunneled beneath the skin to the chest to create a pocket for the implant. Skin transferred as part of the muscle flap will lack sensation. TRAM procedure generally uses abdominal tissue, hence, the risk for hernia or abdominal bulge. The TRAM flap technique carries a 5 percent failure rate, in which case the flap dies and must be removed completely. Despite the challenges of TRAM flap, some advantages do exist. Because of the native circulation and ample fat volume, the TRAM flap feels like a natural breast.
During a review of 325 postmastectomy breast reconstructions, researchers assessed three different methods of breast reconstruction: tissue expansion, LDMF, and TRAM flap. Investigators found the aesthetic successes achievable with the three methods to be similar. Some excellent results were managed with each of the techniques. The failure rate after tissue expansion was significantly higher than those observed with the TRAM and latissimus flaps. Tissue expansion also was not as aesthetically successful as other techniques in obese patients. For immediate breast reconstruction, the TRAM flap was the most successful technique. Although tissue expansion has advantages and may not be the best choice for some patients, methods that used autogenous tissue provided more consistent results.
Krishna S. Vyas
University of Kentucky College of Medicine
Shalin Jyotishi
University of Georgia
Henry Vasconez
University of Kentucky College of Medicine
See Also: Breast: Cell Types Composing the Tissue; Breast: Development and Regeneration Potential; Breast: Major Pathologies.
Further Readings
Allen, R. J. and P. Treece. “Deep Inferior Epigastric Perforator Flap for Breast Reconstruction.” Annals of Plastic Surgery, v.32/1 (January 1994).
Gentile, P., C. Di Pasquali, I. Bocchini, M. Floris, T. Eleonora, V. Fiaschetti, R. Floris, and V. Cervelli. “Breast Reconstruction With Autologous Fat Graft Mixed With Platelet-Rich Plasma.” Surgical Innovation, v.20/4 (August 2013).
Palao, R., P. Gómez, and P. Huguet. “Burned Breast Reconstructive Surgery With Integra Dermal Regeneration Template.” British Journal of Plastic Surgery, v.56/3 (April 2003).
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Breast: Major Pathologies
The study of stem cells has become popular in the fields of research and medicine. Preliminary experiments mostly in animal models suggest that understanding the pathology of stem cells and diseases that occur within the breast can lead to treatments for these pathologies.
Breast and Nipple Anatomy
The breasts, medically referred to as mammary glands, are located at the front of the body overlying the pectoralis major muscle. This includes the base of the breast, which is fixed between the second and sixth rib. Breast anatomy is composed of a network of glandular structures, fatty tissue, blood vessels, and lymphatic vessels.
The breast has three structures: skin, subcutaneous tissue, and breast tissue. The average dimension of a breast is 10 to 12 centimeters and has a thickness of 5 to 7 centimeters. It contains hair follicles, sweat glands, and oil glands. The nipple averages 15 to 60 millimeters in dimension
