POLAND SYNDROME SURGERY IN SPAIN.

Poland syndrome (also Poland’s syndactyly, Poland sequence, Poland anomaly) is a rare birth defect characterized by a partial or total underdevelopment of the chest muscle on one side of the body and on occasion the fingers on the same side (shorter or webbed fingers).

Poland syndrome is more common in men than women and is usually associated with the right side.

Poland Syndrome can also involve the ipsilateral absence of ribs, axillary fold and distortions of the hemithorax. It can include a variety of ipsilateral torso defects and defects in the upper limbs, including agenesis of the anterior portions of ribs 2 to 5, deformity of the sternum. It can also include absence of the latissimus dorsi, serratus, internal and external abdominal oblique muscles. The chest tissues could be small or absent and the areola nipple complex could be small, slightly pigmented and displaced towards the armpit.

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. Although theoretically it would be a good option, it involves sacrificing a healthy and useful muscle. As well as that, with time, the muscle could waste away and require the use of an implant. In the case of men with Poland syndrome, the team of plastic surgeons at Antiaging Group Barcelona (Spain) prefer to use implants and to transfer the patient’s own fat.

The implant replicates the contour of the pectoral muscle and the fat graft hides the inevitable edges of the implant which can be seen subcutaneously.

In athletic and slim patients, who don’t have enough fat, implants give very satisfactory results especially if they are custom-made.

The AnatomikModeling Company creates a custom-made implant based on the chest deformity by means of a CT (CAT) scan. The implant covers and fills in the entire defect and it is implanted following the technique of professor Chavoin (world renowned pioneer in AnatomikModelling implants). It can be reshaped and adjusted in situ during the surgery so that the contours are noticed as little as possible.

The advantages of this surgical technique for Poland syndrome patients are the following:

1. Customized and personalized surgery according to the existing deformity.
2. Silicone material which is soft but solid (it feels like the sternum (chest bone)), and definitive.
3. The edges of the implant adapt to the defect and are also covered by the musculature.

The main disadvantage of this implant is the cost, as they are very expensive. But it needs to be kept in mind that these are lifelong implants which don’t need replacing, as they are made with silicone elastomer, not with gel.

The alternative to silicone implants would be the insertion of chest (pectoral) gel implants. The team of plastic surgeons at Antiaging Group Barcelona (Spain) have devised an innovative technique that makes the chest muscle that has been operated on look very similar to the healthy chest muscle. However, pectoral gel implants can’t be moulded and therefore don’t allow the result to be personalized. Nevertheless, they are an acceptable alternative and they are more economic than the implants that are custom-made.

In patients who have an excess of weight, fat in the abdomen or in the healthy breast, to insert an implant doesn’t satisfy the aesthetic requirements. In these cases, the best thing is to do a graft of the patient’s own fat. Total remodelling is achieved: the contour of the abdomen and flanks (love handles) are improved, the excess tissue from the healthy side of the thorax is removed and the affected side is filled in a way that the contours achieved perfectly simulate the absent muscle. Normally between 300 and 400 grams of fat are injected in.

It is important to bear in mind that regardless of the technique chosen the final result is static, in other words, exercise doesn’t modify it, so the patient himself will have to modulate the volume of the pectoral muscle on the healthy side.

The team of plastic surgeons at Antiaging Group Barcelona (Spain) is the only Spanish centre of reference for AnatomikModeling.

Doctor Jesús Benito’s team has received theoretical and practical training on the computerized construction of 3D implants and the distinct intervention techniques (pectus excavatum, Poland syndrome or other absence of muscles).

This plastic surgery should be carried out when body development has finished. It is very difficult to achieve perfect symmetry as the defect involves the absence of several tissues at the same time.

Yes, it is possible. The new technology allows us to improve the results of patients with Poland syndrome. For patients who have already had an operation for pectus excavatum or Poland syndrome, one of the great advantages of the AnatomikModeling implant is that the prototype is made from the CT (CAT) scan images which by computer engineering reconstructs the defect in 3D, which is still there despite having an implanted prosthesis. Until now, the reconstruction of the defect could not in many cases be complete, but with these moulds developed using computer-aided design the defect is filled in a way that is almost perfect.

Each patient with Poland syndrome is unique and special and needs a prior evaluation to decide if the re-operation is really worthwhile, which scar to do it through and where exactly to place the implant. For all of this, we recommend a visit with our team of specialists in surgery for Poland syndrome at the Antiaging Group Barcelona (Spain) clinic to be able to offer the best option.

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