Breast Deformity Research Articles

One-Stage Correction of Tuberous Breast Deformity Using Saline Implants: Without the Need for Radial Scoring or Lowering the Inframammary Fold

Tuberous breasts are a congenital anomaly in which the breasts fail to develop normally. This abnormality may include hypoplasia, a tubular appearance, a higher inframammary fold (IMF), and sometimes a herniated nipple-areolar complex. Correction of tuberous breast deformity (TBD) is traditionally done with a 1-stage breast augmentation with radial scoring of the constricted breast tissue and/or the lowering of the IMF. An alternative 2-stage approach first uses a tissue expander to correct the deformity; the expander is later replaced with a permanent breast implant. Sixteen patients are presented in which a 1-stage correction of TBD was successfully accomplished with saline implants acting as tissue expanders. In all cases, the expansion remedied the deformity without the need for radial scoring of the breast tissue or lowering of the IMF. This approach has not been reported in the literature. Sixteen women (32 breasts) were treated, with TBD ranging from mild to severe. All patients had a breast augmentation with round, smooth saline implants placed through an IMF incision in the dual plane (partially subpectoral and partially submammary). Implants ranged in size from 225 cc to 675 cc. The IMF was never lowered and the breast parenchyma was never radially scored. Three patients had asymmetry requiring breast implants of different sizes, and one had a circumareolar mastopexy to repair a herniated areolar complex. Representative case examples are provided. The average follow-up time was 9 months. All deformities were corrected, and the patients expressed satisfaction with their results. There were no occurrences of hematoma, infection, capsular contracture, or malposition. This review has shown that saline breast implants alone, with their inherent expansion capability, can correct TBD without the increased morbidity associated with radial scoring and lowering the IMF. For patients who choose saline implants, this single-stage, less invasive surgical approach can provide a good aesthetic result.

De-escalation of complexity in oncoplastic breast surgery: Case series from a specialized breast center

IntroductionOncoplastic breast surgery has evolved the surgical treatment of breast cancer over the past two decades. This practice still lacks validation and poses several dilemmas in terms of safety, local and systemic control, timing of adjuvant treatments and cost-effectiveness. Our case series investigates the effects of a reduced surgical complexity on cosmetic results and quality of life. MethodsWe treated 76 consecutive patients affected by early stage breast cancer from January 2016 to April 2017. We employed a decision support system to assist the final shared decision making. The communication process before surgery included new specific information on recent evidence about local control of disease and outcomes after multimodality treatment. In order to estimate the oncoplastic complexity, we created a new score based on scars, bilateral procedures and type and timing of reconstructions. We compared the outcomes of this series to that of a previous one from the same institution. ResultsThe medium complexity score (CS) in the current series was significantly lower compared to that of the previous series (medium CS cohort 1 = 3.1 vs medium CS cohort 2 = 1.51; p = 0.001). Complications according to Clavien-Dindo classification did not vary significantly between the two series (p = 0.7). The increased use of primary systemic treatment did not translate into a significantly lower mastectomy rate (cohort 1 = 20% vs cohort 2 = 16%; p = n.s.). There was no significant difference in breast deformities after breast conserving surgery (p = 0.2). The BCCT.Core demonstrated a 67.1% occurrence of “good” results. Quality of life in patients who underwent breast-conserving surgery measured using the Breast-Q demonstrated similar results in the pre-post-op assessment. ConclusionsThis study hypothesizes that a proper information may impact on patient's decisions and may reduce surgical complexity. This reduction likely has no effects on the main surgical outcomes estimated using standard tools. More investigations should be performed on a larger multi-institutional scale to confirm these conclusions.

The Medial Pillar Island Flap for Oncoplastic Breast Reconstruction of Upper Pole Defects.

Breast deformity is common following lumpectomy. Use of ptotic lower pole tissue for restoration of volume in the upper pole is quite appealing since it allows for a concomitant lift. This study presents the medial pillar island flap technique of oncoplastic breast reconstruction of upper pole defects. Vascular anatomy of the lower pole of the breast was investigated with cadaver study. The medial pillar island flap was designed utilizing the territory of the inferior pole of the breast as an island flap pedicled medially by the internal mammary artery perforators surrounded by the soft tissue of the medial pillar. It was transposed to the upper pole lumpectomy defect as an independent flap from superomedial pedicle which was utilized for nipple transposition. The dominant internal mammary artery perforator supplying the medial pillar island flap was consistently found in the fourth interspace at a mean distance of 8.5 cm (range, 8 to 10) from the sternal midline. Thirty patients underwent the procedure, with a mean age of 61 years and mean body mass index of 28.9. The average size of the defect was 170 cm(3) (range, 48 to 295 cm(3)). The majority of the patients (n = 28) underwent opposite breast symmetry surgery as well. The average follow up was 12 months. Complication rate was 23.3%. Reoperation rate was 16.7%. There was no evidence of flap compromise or nipple areola complex necrosis. Patient satisfaction was high, with a mean score of 4.1 (range, 2 to 5) out of 5. The medial pillar island flap has reliable vascularity based on the internal mammary artery system. The flap carries lower pole breast tissue as confined by the medial and lateral pillars of a vertical mastopexy design, offering unrestricted arc of rotation for effective reconstruction of upper pole lumpectomy defects as it is completely dissected from the chest wall and the inframammary fold. The two flap design, along with superomedial pedicle, accomplishes versatility for flap inset. The technique was proven to result in safe outcomes without major complications.

Oncoplastic partial breast reconstruction improves patient satisfaction and aesthetic outcome for central breast tumours.

Patients with centrally located tumours involving the nipple-areolar complex (NAC) who undergo breast-conserving treatment (BCT) are at high risk for breast deformity and asymmetry. Immediate oncoplastic breast reconstruction (OBR) can have a favourable impact on surgical outcome. We retrospectively compared aesthetic outcomes and patient satisfaction among women treated with NAC lumpectomy and immediate OBR with patients treated with BCT alone. Aesthetic outcome was evaluated by independent observers, and patient satisfaction was assessed by the BREAST-Q questionnaire. A total of 24 patients were studied, 12 in each group. Demographics and oncological staging were similar in both groups, apart from mean age, hypertension and tumour size/lumpectomy weight. Patients in the OBR group had higher scores for aesthetic outcome and a higher degree of patient satisfaction from the surgical outcome compared to the patients in the BCT-alone group. The immediate OBR approach in the treatment of centrally located tumours with NAC resection has clear advantages over BCT alone. This approach should be considered for and offered to suitable patients.

Abstract P5-16-14: Outcome of lipofilling in patients with a history of breast cancer: A retrospective cohort study

Abstract Background:Autologous fat grafting [AFG] is a surgical technique used to correct breast deformities or to reconstruct partial breast deformities after breast conservative treatment [BCT] or mastectomy for breast cancer. However, a strong debate remains upon the topic of safety and the oncological risk after lipofilling. There is a need for more studies assigned with a higher level of evidence. Objective:This retrospective cohort study aimed to provide a strong evidence-based argument concerning the safety of fat grafting in patients who underwent breast cancer surgery in comparison to a group with similar characteristics who did not receive lipofilling. Methods: Two cohorts consisting of women with a history of breast cancer were retrospectively assembled. All patients underwent BCT and/or a mastectomy as breast cancer treatment. An intervention population of patients that had received primary or secondary lipofilling was statistically compared to a control population of patients that had received a breast reconstruction without lipofilling. Results: Fifty patients with a mean age of 53.6 ± 9.3 years at the time of lipofilling were included in the intervention cohort. The control group included 67 patients with a mean age of 52.8 ± 8.5 years at the time of breast reconstruction. Both cohorts showed no significant differences for demographic or oncological data. Mean follow-up time was 15.0 ± 15.6 months in the intervention group and 45.4 ± 35.1 months in the control group. The prevalence of the complications are shown in the table. No complications were seen in 35 patients [70%] after lipofilling. Fat necrosis was mostly observed [n=15] but no infections or local oncological recurrences were reported. In the control group a complication-free follow-up occurred in 38 patients [56.7%] after breast reconstruction. One control patient demonstrated a local oncological recurrence. A higher prevalence of infections was observed in the control population [p = 0.048] and the prevalence of fat necrosis was higher after lipofilling [p = 0.028]. Prevalence of complications Study populationStudy populationControl populationControl populationp-valueLocal oncological recurrence0 1(1.5%)0.386Infection0 5(7.5%)0.048Fet necrosis15(30.0%)9(13.4%)0.028Microcalcifications3(6.0%)3(4.5%)0.712Other1(2.0%)17(25.4%)0.086- hematoma1(2.0%)5(7.5%) - seroma0 2(3.0%) - capsular contracture0 1(1.5%) -implant leak0 1(1.5%) - implant/flap loss0 6(9.0%) - implant redo0 1(1.5%) - rash0 1(1.5%) None35(70%)38(56.7%)0.142 Conclusion: Lipofilling is a safe technique for breast reconstruction in patients with a history of breast cancer. There is no increase in local oncological recurrence. A side effect is an increase in fat necrosis which can potentially lead to more investigations. Citation Format: Thiessen F, De Schrijver L, De Decker M, Tondu T, Van Goethem M, Tjalma WA. Outcome of lipofilling in patients with a history of breast cancer: A retrospective cohort study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-14.

Inferior pole breast reconstruction by TDAP flap in post-burn breast contracture

Post-burn breast deformities are not an uncommon condition after severe second-degree or third-degree burn and present as severe asymmetry of the breast as compared to the opposite side, displacement of nipple-areola complex, obliteration of inframammary fold, and reduced breast projection. Based on deformities especially for lower pole breast contracture, we propose a new classification to describe breast contracture. There is no tailor-made approach described to deal such deformities. Various options are available ranging from skin graft to different flaps. We present reconstruction by TDAP flap after the release of breast contracture grades I and II. This study aimed to classify the lower pole breast contracture according to its severity and to evaluate the outcome of TDAP flap reconstruction and augmentation of the lower pole of the breast in terms of symmetry and aesthesis. This is a descriptive retrospective study of 10 patients with 15 post-burn contracted breast affecting the inferior pole of the breast and inframammary fold within a period of January 2012 to March 2016 in Kasralainy hospital, Cairo. All cases were evaluated according to flap vascularity, donor site morbidity, symmetry, and esthetic outcome. All flaps survived completely. Flap dimension ranged from 18 × 10 to 22 × 12 cm. The muscle sparing design had been used in three patients due to lack of reliable perforators. Patients were evaluated for their satisfaction, and all of them were satisfied. It is essential to classify the grade of post-burn lower pole breast contracture according to the proposed classification. TDAP is a valuable option in case of grade I and II deformities only. For severe grade III breast contracture, more volume restoring procedure is advisable. Level of Evidence: Level IV, therapeutic study.

Mastoplasty after Massive Weight Loss: Redefinition and Stabilization of the Breast Mound with Submuscular Autoprosthesis.

Context:After massive weight loss, breast changes dramatically becoming ptotic, flat in the upper pole, with significant skin excess. After mastoplasty, often ptosis can recur and the upper pole can lose its fullness again. The technique described in this study treats breast deformities ensuring stable results and avoiding ptosis recurrence.Aim:To analyze a new modality of breast reshaping after massive weight loss, evaluating outcomes and complications as well as patient satisfaction.Settings and Design:This was a case series.Materials and Methods:Fifteen patients (all women, average age, 43.1 years) with bilateral breast ptosis after massive weight loss underwent mastoplasty: the technique included the creation of an inferior pedicle flap that was placed as a prosthesis under the pectoralis muscle and a superomedial pedicle flap containing the nipple–areola complex (NAC). Patients were followed up for at least 6 months, reporting any complications, and measuring the jugulum–NAC distance. Patients’ satisfaction was also reported.Statistical Analysis Used:Nil.Results:All patients were extremely satisfied with the breast volume, shape, symmetry, and ptosis correction. The new mammary contour and the distance between the jugular fossa and the nipple were stable during the follow-up and the upper pole maintained its fullness. No major complications were reported.Conclusion:Mastoplasty with submuscular autoprosthesis proved to be a safe and effective technique to treat breast deformities after massive weight loss because removed redundant tissue repositioned the NAC and filled the upper pole with stable results over time. A similar technique has not been described yet.

Lower pole reconstruction in a post-burn breast using an anterolateral thigh flap: A case report

Severe chest burns in children that prevent breast development at puberty cause challenging problems. Burns result in contracture that lead to size, shape, and positioning problems. In the present case, we used a free anterolateral thigh (ALT) flap to release lower pole contracture in a breast with a burn deformity. A 17-year-old healthy girl had suffered a severed breast deformity due to burn contracture and underwent surgery to release the lower pole contracture of the breast. The patient was followed for 8 months and was satisfied with her final outcome. An ALT flap should be considered as a versatile option for partial breast reconstruction in selected patients who have deformities due to burns.

Surgical treatment of various types of congenital breast deformity in the form of a tubular breast

Surgical treatment of various types of congenital breast deformity in the form of a tubular breast

Tuberous Breast Deformity Correction: 12-year Experience.

This article shows our 12-year experience in application of the technique of breast parenchyma modification with simultaneous augmentation on the tuberous breast. We undertook the study, and with the results of this study we can say that tuberous breast deformation is a common pathology that is caused not only by a thickening of the superficial fascia but also by breast parenchyma fibrosis. When traditional techniques without parenchyma modification are used during the surgery, it is often that patients come back to treat complications. A total of 208 patients (414 breasts) with tuberous breast deformation treated from 2005 to 2017 were included. The mean patient age was 31years (range, 22-53years). A periareolar approach, vertical and horizontal glandular scoring, dual-plane pocket creation, and anatomic implants were used in all cases. The mean follow-up was 36months (range, 3-144months). Deformities of the types I-IV by Von Heimburg were corrected. The global complication rate for all patients in this study was 8.9%-1.4% had capsular contracture, 1.5% had postoperative malposition, 2% had "double bubble" , 2% had rippling, 2% had areola and nipple sensitivity disorder. The authors' experience demonstrates that the described one-stage approach combining mammary gland parenchyma modification (glandular scoring) with dual-plane pocket and anatomic implants provides satisfactory results for treatment of tubular breast deformity with minimal complications and other effects that require repeated treatment. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An algorithm for the management of tuberous breast deformity

Background: There are various categories in the surgical management of tubular/tuberous breast deformity (TBD) that are focused on the laterality [unilateral (U/L) vs. bilateral (B/L)] and the severity of the deformity (grades I to IV). This study reviewed the management of this deformity and found that ‘grade’ and ‘laterality’ to be two important clinical factors in planning a single stage or two-stage procedures. Methods: Outcome evaluation included patient satisfaction following either a single stage or two-stage procedures, which was reassessed over an average period of five years. A number of pre- and post-operative clinical and subjective evaluation criteria, in addition to von Heimburg’s classification were used to assess the grade (severity) of the deformity. Patients were divided into two main groups according to their grades of deformity. Results: Nearly two thirds (60%) of the deformities were unilateral. A total of 95% of patients with lower grades required a single-stage procedure and 50% in the higher grades group. 91% in the lower grades group had implants only. Tissue expansion (TE) followed by implants was the predominant operation in the higher grades group. There was no statistical significance in the patient satisfaction between the two groups. Mean satisfaction score was unchanged after 5 years. Revision rate was nearly two times more in the higher grades patients, and three times more common for the unilateral deformities. Conclusions: The above findings demonstrate that TBD is a difficult clinical problem. The proposed algorithm can serve as a guide to establish a treatment pathway that facilitates better planning and management of this complex deformity.

Chirurgie oncoplastique du sein

Oncoplastic surgery is to treat breast tumors with the help of plastic surgery. Efficiency of breast-conserving treatments (BCT) compared to mastectomies is equivalent. BCT is better accepted but can cause breast deformity, thus further operations. Oncoplastic surgery aims at conserving an acceptable shape to the breast. It ranges from simple remodeling to more complex techniques modifying the width of the breast. According to the quadrant to treat (inner upper, outer upper, inner lower, outer lower, union of quadrants, tumors of the nipple-areola complex, tumors of the inframammary fold), according to the proximity of the tumor to the nipple, and to the size of the breast and tumor, various techniques are displayed. Few touch ups are necessary. Symmetry is managed during the initial operation or after.

Endoscopic Resection of Breast Fibroadenoma

AbstractBackground: Surgical excision was the definitive proce-dure performed for symptomatic benign breast tumors to alleviate anxiety regarding potential for growth or malignancy as well as physical discomfort. However, the efficacy and safety of endoscopic removal of benign breast disease is still a matter of debate.Aim of the Study: The aim of this study is to evaluate feasibility, safety and cosmetic results of endoscopic excision of fibroadenoma of the breast.Patients and Methods: A total of 10 patients underwent endoscopic fibroadenoma excision between June 2016 and August 2017 at General Surgery Department in Tanta Univer-sity Hospital. Patients with recurrent fibroadenoma, multiple swelling or suspicious breast masses were excluded. Cosmetic results, cancer incidence (histopathological surprise), compli-cation rates, and post-operative pain were evaluated.Results: Detailed location of fibroadenoma were in the upper outer quadrant of the breast (n=4, 40%), central supra-areolar lesion (n=3, 30%), and the same presentation for upper inner, lower outer and lower inner lesions (n=1, 10%). Con-version to open technique occurred in two patients (20%). Cosmetic results were excellent in 7 patients (87.5%) and good in one patient (12.5%). Post-operative pain was mild in seven patients (70%) and moderate in three patients (30%). We observed no intra operative bleeding or nerve injury. Subcutaneous emphysema occurred in 3 patients (30%). There was no post-operative seroma, hematoma, wound infection, skin burn nor breast deformity in all cases.Conclusion: Endoscopic resection of breast fibroadenoma is safe and technically simple and is associated with an excellent cosmetic results and a low incidence of complications. Furthermore, it seems to be the optimal procedure, when surgery for benign breast disease is indicated, as endoscopic breast surgery has the advantages of elimination of scars from breast and avoid excess injury of breast tissue.

Bilateral breast reconstruction and pectus excavatum correction: a case and review of the literature

Pectus excavatum is a chest wall malformation characterized by anterior chest wall depression. It is often associated with hypoplastic breasts, sternal rotation, and consequent breast asymmetry. We present here the case of a 52-year-old female with pectus excavatum, a bilateral nipple-sparing mastectomy for breast cancer, and immediate autologous breast reconstruction using bilateral deep inferior epigastric perforator flaps. To correct reconstructed breast deformities and pectus excavatum depression and to enhance breast volume to treat hypoplastic breasts, three sessions of Brava-assisted fat grafting were performed. These postoperative courses were uneventful and without any complications. The patient was satisfied with the final esthetic results. There are only two case reports to perform bilateral breast reconstruction and surgical correction of pectus excavatum, which were used with both pedicle musculocutaneous flap and breast implant, with or without a sternal implant. In this study, we discuss indications and surgical options for bilateral breast reconstruction, pectus excavatum, and breast augmentation. Level of Evidence: Level V, therapeutic study.

A rare unilateral giant fibroadenoma of the breast during pregnancy and lactation

: Fibroadenomas are the most common breast masses in adolescent women. Giant fibroadenomas are an uncommon disease during pregnancy and lactation. Significant enlargement might result in breast asymmetry and deformity. We present a rare case of giant fibroadenoma during pregnancy and lactation with significant breast asymmetry. Excision with round block technique leaves a discrete scar and a cosmetic contour.

A rare unilateral giant fibroadenoma of the breast during pregnancy and lactation

Fibroadenomas are the most common breast masses in adolescent women. Giant fibroadenomas are an uncommon disease during pregnancy and lactation. Significant enlargement might result in breast asymmetry and deformity. We present a rare case of giant fibroadenoma during pregnancy and lactation with significant breast asymmetry. Excision with round block technique leaves a discrete scar and a cosmetic contour.

The COSMAM TRIAL a prospective cohort study of quality of life and cosmetic outcome in patients undergoing breast conserving surgery

BackgroundCosmetic result in breast cancer surgery is gaining increased interest. Currently, some 30–40% of the patients treated with breast conserving surgery (BCS) are dissatisfied with their final cosmetic result. In order to prevent disturbing breast deformity oncoplastic surgical techniques have been introduced. The extent of different levels of oncoplastic surgery incorporated in breast conserving surgery and its value with regard to cosmetic outcome, patient satisfaction and quality of life remains to be defined. The aim of this prospective cohort study is to investigate quality of life and satisfaction with cosmetic result in patients with breast cancer, undergoing standard lumpectomy versus level I or II oncoplastic breast conserving surgery.MethodsFemale breast cancer patients scheduled for BCS, from 18 years of age, referred to our outpatient clinic from July 2015 are asked to participate in this study. General, oncologic and treatment information will be collected. Patient satisfaction will be scored preceding surgery, and at 1 month and 1 year follow up. Photographs of the breast will be used to score cosmetic result both by the patient, an independent expert panel and BCCT.Core software. Quality of life will be measured by using the BREAST-Q BCT, EORTC-QLQ and EQ-5D-5 L questionnaires.DiscussionThe purpose of this prospective study is to determine the clinical value of different levels of oncoplastic techniques in breast conserving surgery, with regard to quality of life and cosmetic result. Analysis will be carried out by objective measurements of the final cosmetic result in comparison with standard breast conserving surgery. The results of this study will be used to development of a clinical decision model to guide the use oncoplastic surgery in future BCS.Trial registrationCentral Commission of Human Research (CCMO), The Netherlands: NL54888.015.15.Medical Ethical Commission (METC), Maxima Medical Centre, Veldhoven, The Netherlands: 15.107.Dutch Trial Register: NTR5665, retrospectively registered, 02-25-2016.

Current Approaches Including Novel Nano/Microtechniques to Reduce Silicone Implant-Induced Contracture with Adverse Immune Responses.

Capsular contracture, which is the pathologic development of fibrous capsules around implants, is a major complication of reconstructive and aesthetic breast surgeries. Capsular contracture can cause implant failure with breast hardening, deformity, and severe pain. The exact mechanisms underlying this complication remain unclear. In addition, anaplastic large cell lymphoma is now widely recognized as a very rare disease associated with breast implants. Foreign body reactions are an inevitable common denominator of capsular contracture. A number of studies have focused on the associated immune responses and their regulation. The present article provides an overview of the currently available techniques, including novel nano/microtechniques, to reduce silicone implant-induced contracture and associated foreign body responses.

Characterizing Breast Deformities After Massive Weight Loss: Utilizing the Pittsburgh Rating Scale to Examine Factors Affecting Severity Score and Surgical Decision Making in a Retrospective Series.

Massive weight loss (MWL) can result in variable contour deformities of the breasts. The Pittsburgh Rating Scale (PRS) was designed to describe the multitude of deformities after MWL and recommends operations to consider for surgical improvement. We present the first comprehensive description of breast deformities in a large sample of MWL patients, examine factors affecting the severity of deformities, and report the correlation between PRS score and surgical decision making. A retrospective review of all MWL patients presenting for breast surgery at our institution's Life After Weight Loss program from 2004 to 2015 was performed. Information including demographics, body mass indices (BMIs), method of weight loss, and type of surgical intervention was collected. Preoperative breast photographs were blinded and scored according to the PRS. A total of 204 MWL patients were identified; 26% (53) scored 1, 34% (69) scored 2, and 40% (82) scored 3 on the PRS. Greater deformities were seen after weight loss from bariatric surgery versus diet and exercise alone (P = 0.031), in mastopexy versus augmentation/mastopexy (P = 0.001), and in breast reduction versus augmentation/mastopexy patients (P > 0.0001). Patients who underwent reduction mammaplasty had the greatest maximum BMI compared with other procedures (P = 0.016). The PRS scores were positively correlated to maximum BMI (P < 0.001), delta BMI (P < 0.001), and current BMI (P < 0.001). Massive weight loss patients have variable, and often severe, breast deformities, and the PRS remains a valuable classification tool. Severity scores correlate with BMI, procedure, and weight loss mechanism. Similar scores between mastopexy-only and reduction mammaplasty patients may reflect a composite of personal cosmetic expectations and cost. The PRS scale should also be expanded to include breast reduction as a surgical remedy for PRS grade 3 breast deformities. Understanding breast deformities in this unique population has applications in both preoperative planning and surgical expectations for this unique patient population.

A rare approach? Microsurgical breast reconstruction after severe burns

Breast deformity, in post-burn patients, is a common problem leading to lower self-esteem and reclusive behavior that impairs quality of life. The authors present the course of treatment of an 18-year-old immigrant girl who suffered second- to third-degree burns over approximately 20% of her total body surface area in her early childhood. The second- to third-degree burns were located on her right trunk and abdomen, as well as her right shoulder, neck, and right groin area. Since it was not offered in her home country, reconstructive surgery, including microsurgical breast reconstruction, was sought abroad. Due to the lack of available skin and soft tissue, a bilateral breast reconstruction with free transverse myocutaneous gracilis flaps was offered. This case illustrates one method of using microsurgery to address post-burn breast deformities in order to alleviate psychological suffering and improve quality of life.