POLAND SYNDROME RECONSTRUCTIVE SURGERY

Poland syndrome (also called Poland sequence or Poland anomaly) is a rare birth defect described by Alfred Poland in 1897.

The cause is unknown. However, researchers suggest that it may result from a disruption of blood flow of one of the main arteries to the chest and arm (subclavian artery) during the sixth week of pregnancy.

Poland syndrome is characterized by a partial or total absence of the pectoralis major muscle (chest muscle) on one side of the body.

However, this syndrome can include a spectrum of chest-wall deformities affecting the rib cage (absence of ribs) and the chest wall muscles (underdeveloped). It can also affect the spinal curvature making it deviate to one side (scoliosis).

Patients with Poland syndrome could present with upper extremities deformities and webbing fingers. Also, there are some abnormalities in the breast and nipples, including under-developed (hypoplastic) glands or absent nipples.

Most of the treated cases are mild and present with the absence of the pectoralis muscle only, though.

Poland syndrome is more common in men and usually affects the right side (70%).

Unlike women, surgery to correct Poland syndrome in men is usually done after adolescence. Currently, transferring the latissimus dorsi muscle to the chest is avoided. However, it was the preferred technique a few years ago.

Even though it would be a good option, it involves sacrificing a healthy and useful muscle to correct an aesthetic defect. Additionally, with time, the muscle could waste away and require the use of an implant.

In the case of men, the best option to correct Poland syndrome is to use implants in combination with fat grafting.

The implant replicates the contour of the pectoral muscle, and the fat graft hides the edges. This prevents the contour of the implant from being seen under the skin.

According to Dr. Benito: “Implants, although not perfect, provide a simple and quite satisfactory solution to the problem in one surgical stage. Implants can be custom made, leading to a better result as we can match the opposite, normal side.”

Nowadays, through a CT scan, the Anatomik Modeling Company can create a custom-made implant based on the chest deformity. The implant is specially designed to cover and fill it perfectly.

The technique is simple, definitive (life-long implants), and guarantees high-quality results. Also, the medical silicone material, which is soft but solid, gives a natural feel.

Antiaging Group Barcelona is the only Spanish center of reference for Anatomik Modeling. Doctor Benito has received extensive training on the computerized construction of 3D implants and intervention techniques.

The alternative to custom-made implants would be the insertion of a chest (pectoral) implant. 

Doctor Benito uses an innovative technique that makes the chest muscle that has been operated on look very similar to the healthy one.

However, pectoral gel implants can’t be molded. Therefore, they don’t allow the result to be personalized. But they are an acceptable alternative to correct Poland syndrome, and they are less expensive than custom-made implants.

In Poland syndrome, the main and most visible deformity is an axillary deficiency.

In that case, Dr. Benito uses the contralateral implant and rotates it to leave the thickest and most projected part of the implant at the axillary pole. Meaning, he uses the left implant, rotated clockwise, on the right side, and vice versa for the left side.

Though males are affected more than females, more Poland syndrome girls seek attention due to problems with breast development. If the breast is absent, very underdeveloped (hypoplastic), or misshapen, it’s time to consider plastic surgery.

In the case of women, Poland syndrome can cause significant asymmetry. For that reason, it is usual to treat patients when they are teenagers, while men are usually treated later.

Surgery for women boosts their self-esteem and improves their body image.

The simplest cases of Poland syndrome in women can be treated satisfactorily with a breast implant. However, this option could accentuate the sunken subclavicular space.

Also, because of the natural lack of parasternal tissue, the implant could migrate to this space. This causes bad positioning in the upper part.

For that reason, a more complex approach is needed, including treatments in the breast implant, such as:
– Customized implant
– DIEP flap
– Latissimus (dorsi) muscle transfer
– Fat grafting

In the case of Poland syndrome in women, total breast reconstruction is necessary. Depending on the muscle atrophy (wasting) that exists, it may be required to turn to various combined techniques. 

This technique is necessary for thin patients who need to cover up the implant or expander so that it cannot be seen.

Also, it is useful if the anterior armpit (axillary) skin fold is absent due to the lack of the underlying pec major muscle.

The latissimus dorsi muscle from the back is mobilized and swung under the armpit. Then, it is reattached to the upper arm bone (humerus) to mimic the natural fold. However, this will leave a large scar on the back.

Another disadvantage is that a muscle has to be sacrificed. In the long term, it could waste away and lose volume, according to case reports.

However, there are other options. The breast can be reconstructed using a DIEP flap. This technique takes abdominal fat and skin (without the muscle) to provide more breast volume.

These procedures are commonly employed to reconstruct the breast after breast cancer surgery.

Poland syndrome surgery cost depends on the physical features of the patient and of the technique used.

Each patient is unique and special and needs a prior evaluation. For all of this, we recommend a first free visit with Doctor Benito to be able to offer the best option.

The patient can consult with the surgeon regarding all their doubts and worries.

There is a solution to Poland syndrome, but it requires treatment and medical advice by a plastic surgeon with wide experience in this field.