Burned breast reconstructive surgery with Integra dermal regeneration template  R. Palao, P. Gómez, P. Huguet  British Journal of Plastic Surgery  Volume 56, Issue 3, Pages 252-259 (April 2003) DOI: 10.1016/S0007-1226(03)00101-2

Fig. 1 (a) At one month after Integra grafting, neodermis characterized by thick collagen fibres was present interspersed among still remaining Integra collagen matrix. New vessel formation was evident. Elastic fibres and cutaneous appendages were not present in the Integra graft, but elastic fibres, stained black with the Verhoeff Van Giesen method, were present in adjacent normal tissue (lower section of image). Biopsy was taken prior to autograft, and thus epidermis is not present. (b) At one year after Integra placement, neodermis is highly vascularized and contains a thick layer of organized host collagen. Elastic fibres of irregular configuration and distribution are present, as well as small areas of residual Integra matrix. Rete ridges have formed at the dermal-epidermal junction. No cutaneous appendages are present. Magnification of 100×. British Journal of Plastic Surgery 2003 56, 252-259DOI: (10.1016/S0007-1226(03)00101-2)

Fig. 2 Preoperative (a) frontal and (b) oblique view. (c, d) At 14 months follow-up, bilaterally treated breasts are of good shape and contour, but hypertrophic scars have occurred at the edges of the Integra graft where normal skin and graft meet. Scars were treated twice with locally-injected corticosteroids at an interval of one month. Some tightness has reoccurred in the left breast, but a re-release is not needed at this time. British Journal of Plastic Surgery 2003 56, 252-259DOI: (10.1016/S0007-1226(03)00101-2)

Fig. 3 Frontal view (a) before surgery and (b) at 8 months follow-up, at which time the right breast had attained a much improved shape and contour and good symmetry with the contralateral breast. (c) The lateral thoracic donor site at 8 months of follow-up has achieved an excellent cosmetic out-come. British Journal of Plastic Surgery 2003 56, 252-259DOI: (10.1016/S0007-1226(03)00101-2)

Fig. 4 Preoperative (a) frontal and (b) oblique view, showing tight skin envelope on right burned breast. (c, d) At 1 year follow-up this 27-year-old patient now has good mammary contour, and contracture has not recurred. British Journal of Plastic Surgery 2003 56, 252-259DOI: (10.1016/S0007-1226(03)00101-2)

Fig. 5 Preoperative (a) frontal and (b) oblique view. (c, d) At 6 months of follow-up, the breast has improved shape and contour, but hyperpigmentation has occurred at the graft site. (e, f) At 14 months, improvement of breast contour has been maintained, and hyperpigmentation, although still present, has lessened. British Journal of Plastic Surgery 2003 56, 252-259DOI: (10.1016/S0007-1226(03)00101-2)