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Answers to Common Questions
What is the right age to correct the chest deformity in Poland's syndrome?
If the patient is lucky enough to have had the diagnosis made by the pediatrician, then developmental changes and abnormalities are not unexpected. Often, as the child begins to develop, one breast becomes much larger than the other. First one must consider whether in fact this patient does have Poland's syndrome. Many young girls will develop differently on each side of their chest. There are two issues, the first is when to react, and the second is how to react. This child is likely to be very self-conscious of her appearance and this may interfere with participating in activities such as gym or going to summer camp. Additionally, this will affect how the child will dress. While generally I prefer to wait until whose child has fully developed before beginning any correction, there are some situations that require intervention sooner. If the child is suffering and not interacting with others in a normal way then sometimes placing an implant beneath the smaller breast may give this child the self-confidence she needs to interact normally. This is done knowing full well that this implant may not be the right endpoint and may need replacement or additional procedures later on.
What is the right procedure to correct the Poland's syndrome deformity?
Despite the fact that I am an advocate of flap reconstruction of the breast, many patients who have only a small to moderate size discrepancy in the breasts do quite well with a breast implant. There are some patients whose deformity is not suited for an implant, and in those patients, a flap would be most appropriate. There are patients who have had multiple implants over the years and would like something that does not require ongoing maintenance. In those patients, a flap would also be appropriate. Young patients rarely will have enough abdominal tissue to perform a DIEP flap. While a GAP flap is sometimes done, the geometry and thickness will determine if this is an option.
If the patient has had multiple implant procedures, are they still a candidate for DIEP flap or GAP flap breast reconstruction of the Poland's defect?
If the patient has enough abdominal tissue in order to make the appropriate breast, then the DIEP flap is clearly an option. In fact, not putting any further foreign material in that breast which is already scarred will give the best reconstruction for this patient.
What if there are chest and rib deformities, is the patient still a candidate for a DIEP or GAP flap breast reconstruction? What about implant reconstruction?
Generally, the rib and chest deformities are not a problem with either flap or implant breast reconstruction. Each individual however, must be evaluated to determine if it is wise and safe to proceed. Most patients with Poland's syndrome are missing some or all of their pectoralis major muscle. This is the main muscle on the chest. If there is only a small amount of overlying breast tissue, then implant reconstruction may not be desirable. Absence of a portion or the complete pectoralis muscle is not a problem for successful breast reconstruction with the DIEP or GAP flap.
Additional Resources on Poland's Syndrome:
This Web site offers a wealth of information for people living with Poland's Syndrome, including frequently asked questions and diagnosis information.
This site has an excellent discussion forum on Poland's Syndrome where people can raise questions and support each other.