POLAND SYNDROME RECONSTRUCTIVE SURGERY : A COMPLETE GUIDE FOR MEN A WOMEN

Poland Syndrome is a congenital deformity that can be very troublesome for both men and women. It is not easy to hide a chest defect when wearing fitted clothes. This can also impact self-esteem and bring about intimacy or body image problems.

Nowadays, there are advanced surgical options to fix this problem. Are you the right candidate? Will you get good results? Is it painful?

Keep reading to find out everything about Poland Syndrome surgical options.

WHAT IS POLAND SYNDROME?

Poland’s Syndrome (also called Poland sequence or Poland anomaly) is a rare birth defect described by Alfred Poland in 1897. It is more common in men and usually affects the right side (70%).

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.

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

Medically reviewed by Dr Osama Bahsas Zaky
Written by Joaquín Pineda
Updated on August 3, 2021

What Is Poland Syndrome?

The First Consultation.

How Is Poland Syndrome Corrected In Men?

Poland Syndrome Surgery with Custom-Made Implant.

The Pec Implant: A Less Expensive Alternative.

Fat Grafting for Chest Reconstruction.

Recovery and Results.

How Is Poland Syndrome Corrected In Girls?

Implants/Expander.

Flaps.

Fat Grafts.

Poland Syndrome Surgery Cost.

The First Consultation

The first consult is of utmost importance. On top of checking your overall health status, your doctor needs to identify your goals and expectations. If they are unrealistic, he will explain an alternative treatment plan specially tailored for your case.

The physical evaluation should measure the chest contour, perimeter, and rib curvature. Also, it must consider the muscular asymmetries (different shapes and volumes of the muscles) and the width of each hemithorax.

For these measures, the patient should be standing. Also, the evaluation should consider the muscles both relaxed and contracted. Dynamic evaluation is crucial because the muscles notably change in shape and length.

All these factors must be considered when choosing the right implant!

Poland Syndrome in Men

How Is Poland Syndrome Corrected in Men?

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.

POLAND SYNDROME SURGERY WITH CUSTOM-MADE IMPLANT

The custom-made implant will fill and replace the pectoralis major muscle. This guarantees perfect symmetrization of the chest and, in girls, symmetrization of the breast too.

The implant is placed through a small incision (4 cm) in the axillary area, so the scar is barely noticeable. Because the muscle is absent in these patients, the implant is placed directly under the skin or the fascia (muscle lining).

The implant has a textured shell, mostly to prevent any displacement. The shape of the implant mimics the outlines of the pectoral muscle. It is rectangular, with an axillary extension.

Your surgeon will choose the implant depending on your muscle shape and the available pocket. Demanding the largest volume possible is not recommended.

The implant is perfectly stabilized inside its subcutaneous pocket so that it doesn’t move, even downwards. Then, the surgeon closes up using absorbable stitches. Finally, he applies a circular compression bandage on the chest. Drains are not placed.

The procedure is typically completed in 1 hour, under general anaesthesia. It presents minimal risks and a hospitalization period of 3 days maximum.

The Pectoral Implant: A Less Expensive Alternative

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 patients with 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.

FAT GRAFTING FOR CHEST RECONSTRUCTION

Some males may only be affected by the loss of the chest’s contour due to the absence of the lower part of the major pec muscle.

In this situation, the transfer of small amounts of fat from the abdomen, thighs, or buttocks may help disguise the contour abnormality. This technique can also increase the anterior skin fold by the armpit, which is often hollow in patients with Poland Syndrome.

Dr. Benito can achieve total remodeling: the contour of the abdomen and flanks (love handles) is improved, and the excess fat from the healthy side of the thorax is removed. Then, the affected side is filled in a way that the contours perfectly simulate the absent muscle.

Recovery and Results

Anti-inflammatory drugs, such as ibuprofen and antibiotics, are given for one week. The surgeon does not usually prescribe compressive garments.

Patients should follow postoperative recommendations down to the T. For example, it’s crucial to avoid any strenuous activity for the first six weeks. However, patients can elevate the arm to stretch the muscles and the axilla. It is normal to feel tightness in the axilla for some weeks until the scar softens. Don’t panic!

Ultrasound is used routinely during your recovery checkups to monitor the implant and the presence of periprosthetic fluid (seroma) surrounding the implant. Periprosthetic fluid can be aspirated if needed.

After six weeks, you will be cleared to start exercising. Begin with low-weight repetitions, increasing the resistance weekly. If you notice a sudden increase in pectoral volume, stop immediately and get checked.

If the postoperative period goes smoothly, the patient can return for evaluation one month after starting exercise, with additional follow-ups at 4 and 12 months.

How Is Poland Syndrome Corrected in Girls?

Though males are affected more than females, more girls with Poland Syndrome 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 girls, 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 boosts their self-esteem and improves their body image.

The simplest cases 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 some cases, total breast reconstruction is necessary. Depending on the muscle atrophy (wasting) that exists, it may be required to turn to various combined techniques.

Implants/Expander for Female Poland Syndrome Reconstructive Surgery

In mild deficiencies, an anatomic implant can be inserted to give volume and shape to match the contralateral side.

The reconstruction can be completed after a minimum of 6 months after implanting a customized chest implant. Generally, the surgeon will place a breast implant in a separate compartment using the same axillary approach.

If there is significant asymmetry, it may be necessary to insert an expander which allows the skin to be stretched to create space. Then, the expander is later replaced with the definitive implant.

Expanders are silicone breast implants that can be filled with saline solution to increase their size. A tube comes out the back of the implant, and it is possible to inject with 50 – 100 ml of saline to achieve breast expansion.

Generally, several expansions are required over a period of weeks to reach the desired volume. This expander can be left in place or converted to a definitive silicone breast implant later when skeletal growth ceases at 18.

The problem with both the expander and the implant is that the edges may be visible and give a somewhat artificial appearance. For that reason, sometimes, it is necessary to combine an implant with a fat graft or with a latissimus dorsi muscle flap.

Flaps

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.

Fat Grafts

Fat grafts are a natural technique that is increasing in popularity in female patients with Poland Syndrome. If the patient has enough stored fat, the cells can be transplanted to the breast. This allows greater versatility in the shape.

Also, putting an implant can be avoided. Remember that implants have a lifespan, so it is easy that they may need to be replaced throughout life.

HOW MUCH POLAND SYNDROME SURGERY COSTS?

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.

WHY CHOOSE DOCTOR BENITO FOR YOUR POLAND SYNDROME SURGERY?

With more than 20 years of experience, Doctor Jesús Benito is known worlwide for his technique to correct the Poland Syndrome by using custom-made Anatomik Modeling implants.

Reconstructive surgery using custom-made implants is a personalised, safe and easy procedure which avoids open chest surgery and its possible complications.

Antiaging Group Barcelona is the only centre of reference in Spain for Anatomik Modeling.v

Doctor Jesus Benito - Plastic Surgeon

Doctor Jesús Benito

Specialist in plastic and cosmetic surgery.
Worldly renowned in muscle implant surgeries for men.

Secretary of the ISAPS (International Society of Aesthetic Plastic Surgery).
Former president of the Spanish Association of Aesthetic Plastic Surgery (AECEP).
2013 Gold Medal (Forum Europa)

More information about the medical team.

Bibliography & Publications:

Benito-Ruiz J. “Male chest contouring with Implants”. En: Encyclopedia of Aesthetic Rejuvenation through volume enhancement. Herman CK, Strauch B. (Eds), 2014, p 303.
Tratamiento de síndrome de Poland en Hombres. III Congreso Ibérico de Cirugía Plástica, Estoril, 2 a 4 de junio de 2016.
Aesthetic reconstruction of Poland syndrome in males. ISAPS Congress Kyoto 2016.

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Dr Benito and Dr Salvador - Antiaging Group Barcelona

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