15.  In an adolescent girl with a 3rd-degree chest burn, how should the breast area be treated acutely and chronically?  (PRS 1989; 83:676  PRS 1982; 70:718)

Answer:
Acutely, the breast bud tissue should be preserved by allowing the eschar surrounding the nipple to demarcate completely and then excised tangentially to viable tissue. A conservative approach is essential for maximizing the chances of breast development. Contractures of the anterior chest wall should be released when they restrict the normal growth of pubescent breast.  Transposition flaps or skin grafts can be used.  Contracture release of the breast mound should be completed and fully settled (6-12 months) prior to nipple-areola reconstruction. If one nipple and areola has been spared it can be used for nipple-areola reconstruction.
 

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