As a rare congenital condition Poland Syndrome affects the chest, breast, and sometimes the upper extremity (arm and hand) on one side of the body. Generally, the pectoralis major muscle is absent or underdeveloped, and the overlying breast is absent, small or misshapen. Males are three times more commonly affected than females, and the right side is affected twice as often as the left. Occasionally other anatomic features are present such as sternum or rib anomalies, and Poland syndrome can occasionally be associated with other congenital syndromes.
As breast asymmetry develops during puberty, young women seek cosmetic correction of their breast and chest wall. In fully developed women, there may be a smaller breast on the affected side, or absence of the breast altogether. The nipple and areola is often smaller and sits higher than the other side, or it may also be absent. The underlying chest wall is often depressed or misshapen, and the normal contour of the pectoralis major muscle is missing. Each of these features can potentially be corrected or improved by Plastic Surgery.
Most women seeking reconstruction are looking to reconstruct their breast and/or chest wall. Correction of Poland syndrome can include breast implant reconstruction, insertion of specialized pectoral implants, free flap reconstruction, nipple and areola reconstruction and other complimentary procedures to
Correction of Poland syndrome is appropriate for both men and women. Good candidates for reconstruction related to Poland syndrome include individuals who are healthy, physically fit and of a normal body weight. Younger women should have finished puberty and have had stable breast size for at least a year before surgery.
Smokers, patients with diabetes, multiple medical problems or blood-clotting disorders are often not good candidates for reconstruction. Morbidly obese patients have a much higher rate of complications and are advised to achieve a more optimal weight prior to reconstructive surgery. Your past medical history and current medical status will be evaluated at your consultation. You may be asked to see your Primary Care Physician for a full physical examination and appropriate laboratory tests prior to being medically cleared for surgery.
A breast implant is usually inserted to replace missing breast volume on the affected side. Traditional implant reconstruction involves two stages where a tissue expander is placed in one operation and a permanent implant is placed in a second procedure. However, a new technique that does not require tissue expanders as a preliminary step, provides the most natural looking results and enables breast reconstruction in a single operation is available as an exciting option for Poland syndrome patients.
A permanent, postoperatively adjustable breast implant is used to augment or create a natural breast form. It can be tailored as needed after surgery to suit a woman’s body, her curves, lifestyle and individual aesthetic goals. Many of the steps of surgery are the same as for breast cancer reconstruction.
Specialized shaped implants designed to fill in the chest wall defect in Poland syndrome are available. Many men with Poland syndrome seek this option for reconstruction. Pectoral implants are made of silicone gel and are custom-ordered after a complete history, physical examination and detailed measurements are taken by your surgeon. Insertion of a pectoral implant requires creation of a potentially large scar, usually beneath the breast area or in the armpit region. Because subcutaneous fat in the chest region is also missing, a pectoral implant may have a visible edge and look less natural than using the body’s own tissue.
Use of the body’s own tissue for reconstruction is called a “Flap”. A “Free Flap” is a specialized reconstructive procedure that transplants tissue from an area of excess to reconstruct the breast, chest wall depressions and any additional abnormalities or hollows in Poland syndrome.
Microsurgery offers exciting new options for Poland syndrome reconstruction using the body’s own tissue and avoiding the sacrifice of major muscles. Fatty tissue is taken from the tummy or the inner thigh area and Microsurgically transplanted to the chest region as a Free Flap. While traditional flaps from the tummy permanently sacrifice another major body muscle such as the TRAM flap; we do not recommend this procedure for our patients here at Iranian Surgery and instead offer muscle-sparing surgical options.
Innovative, state-of-the-art reconstruction methods for Poland syndrome include “Perforator Flaps” known as the DIEP flap, SIEA flap and TUG (inner thigh) free flap. These surgeries are only performed by specially-trained Reconstructive Microsurgeons with a great deal of experience in breast reconstruction.
A traditional method for Poland syndrome chest wall correction is the Latissimus dorsi (LAT) flap. The Latissimus is the largest muscle in the body and is used in almost all activities of daily living. In Poland syndrome, because the major chest muscles on the front (Pectoralis major and occasionally Pectoralis minor) are already missing, to additionally sacrifice another major muscle from the back can increase potential weakness and deformity of the trunk, and makes little sense! For this reason, the LAT flap is not usually recommended.
If the nipple and areola is absent or malformed, a new nipple prominence and an areolar circle can be reconstructed. Nipple reconstruction can be done at the same time as breast correction or occasionally is performed as a second outpatient procedure 3-6 months later.
Occasionally, free fat grafting (also known as “lipofilling”) can help to fill in contour defects above the breast in the upper chest region, where the pectoralis major muscle is missing. Fat can be taken (“harvested”) from one area of the body using a Liposuction wand and vacuum and is transferred to fill in an area that is not corrected by traditional reconstructive methods (for instance, above a breast implant below the clavicle, or collarbone). Fat grafting is only used in special reconstructive situations and is generally not recommended in routine cosmetic procedures.
When fat is transferred by lipofilling, some of the fat will survive and some cells will not. Calcifications can form in the area of fat grafts that do not “take” (survive); this can show up as abnormalities on a mammogram. For this reason, free fat grafting is only recommended in small areas where there is not normal breast tissue, such as in Poland syndrome or after mastectomy for cancer with reconstruction. Correction by lipofilling may be complete following a single session of fat grafting. Commonly up to three procedures staged 3-6 months apart may be needed. Fat graft surgery is done in the operating room as an outpatient procedure, and may or may not be covered by insurance.
A balancing procedure is often recommended for the opposite breast to match the reconstructed breast for all types of reconstruction. Balancing procedures may include a breast reduction, breast lift, or breast augmentation based on the details of your body, your Poland syndrome and your method of reconstruction. Your surgeon will examine both sides of your chest and will recommend the procedure(s) that best meet your goals and that provide the best aesthetic results with the greatest balance and symmetry.
Iranian surgery is an online medical tourism platform where you can find the best doctors and surgeons in Iran. The price of Poland Syndrome Treatment in Iran can vary according to each individual’s case and will be determined by an in-person assessment with the doctor.
For more information about the cost of Poland Syndrome Treatment in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946. This service is completely free.