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What Is Poland Syndrome?

Poland syndrome is a congenital disorder that affects chest and breast development on one side of the body. Women with Poland syndrome may experience chest deformities such as missing or underdeveloped pectoral muscles and asymmetric or underdeveloped breasts. Some women may also have a missing nipple-areola complex.

Poland Syndrome Reconstructive Surgery

Many of the deformities with Poland syndrome can be corrected with reconstructive surgery. We offer corrective procedures such as implant-based or autologous breast reconstruction, chest wall implants, and nipple-areola reconstruction. Each of these procedures can help restore a more symmetric and natural look to the side affected by Poland’s syndrome.

For breast reconstruction, we offer the latest in microsurgical flap reconstruction, including DIEP, SIEA, TUG, and PAP flaps. We recognize that women with Poland syndrome may have problems with muscle development, and as such, we try to avoid procedures such as TRAM or Latissimus Dorsi flaps that remove muscle as well as fat. During your visit, Dr. Tanna will work with you to design a breast reconstruction plan that’s personalized to match your experience with Poland syndrome.

Case Study: Poland Syndrome Reconstruction With Flap

The photos in this case study show a 24-year old patient with a severe case of Poland syndrome.

At age 18, she underwent breast reconstruction with a tissue expander and saline implant, but subsequently developed grade IV capsular contracture.

The patient elected to have breast reconstruction done with her own tissue (flap). The saline implant in the right breast was removed during the procedure. A profunda artery perforator (PAP) flap was harvested from the posterior thigh. The bottom photos show the right breast reconstructed with a PAP flap, one year after surgery.

(Left, top left, and top right) Preoperative photographs showing right breast capsular contracture and asymmetry. (Bottom right) Preoperative MRI displaying muscle underdevelopment and absence of ribs.

Appearance of breast reconstruction and donor sites at 1 year postoperatively.


What is the right age to correct the chest deformity in Poland 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 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. A child with Poland syndrome 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 it’s generally preferable to wait until the 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 size in the long term and may need replacement or additional procedures later on.

What is the right procedure to correct the Poland Syndrome deformity?

Although flap reconstruction is a great option for Poland syndrome correction, 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 or SIEA flap. While a GAP, TUG, or PAP flap is sometimes done, the geometry and thickness will determine if these will be an option.

If the patient has had multiple implant procedures, are they still a candidate for flap-based breast reconstruction?

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 flap-based 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 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 an autologous tissue flaps.

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