Background: Poland’s syndrome is a very well known set of congenital malformations involving one side of the chest and arm. The complete set of findings include a smaller hand with webbing and an underdeveloped sterno-clavicular portion of the pectoralis muscle. This results in a smaller chest on the affected side with a less developed nipple and muscle. It occurs five times more frequently on the right side and two or three times as often in males.
The key feature and often the one of greatest concern to a patient is the chest deformity. The distal end of the pectoralis major muscle that attaches to the lower end of the sternum is missing. This is technically known as aplasia of the sternal head of the pectoralis muscle. Regardless of the name, this appears as a smaller and asymmetric chest shape in men.
No amount of exercise will develop an asplastic pectoralis muscle to match the contralateral normal side. The muscle is simply smaller and making what exists bigger through weight training will not create enough muscle mass. Exercise-induced muscle hypertrophy does help but some form of reconstruction is necessary to get the best chest symmetry possible.
Case Study: This 33 year-old male presented for a right pectoral implant. He had always had a smaller chest on the right side as well as a deviated and lower positioned right shoulder. There was some slight skin webbing across the axilla and he had a small web between the third and fourth finger of his right hand. He had never been given the formal diagnosis of Poland’s syndrome.
Under general anesthesia, an incision was made high up inside the right armpit. Dissection was carried under the pectoralis muscle which was difficult as it was very fibrotic and adhered to the chest wall. The muscle could be felt to be short in length. Dissection was carried down below the edge of the muscle to a predetermined skin mark that matched the lower edge of the pectoralis muscle on the opposite side. A soft flexible silicone elastomer pectoral implant was used of a style 1 shape. Its maximal projection was 3 cms. After trying it in, it was cut down in size by about 1/3. It was then re-inserted and the incision closed. No drain was used.
His postoperative course was typical for any other pectoral implant surgery. He was sore and swollen but by three weeks after surgery was back to all normal activities. He resumed full weight training one month after surgery. His chest symmetry was much improved.
For mild to moderate chest asymmetries due to pectoralis muscle deformities, a traditional silicone elastomer pectoral implant can be very helpful. Adjustments to the size and shape of the implant are often needed to avoid creating a chest appearance that is bigger than the normal side.
Case Highlights:
1) Poland’s syndrome causes underdevelopment of one side of the chest, shoulder and arm, including the pectoralis muscle.
2) An increase in the size of the pectoralis muscle in Poland’s syndrome in men can be done with a pectoral implant.
3) A pectoral implant is inserted through a transaxillary incision under the pectoralis muscle. It will usually have to be modified down in size for a more custom approach to the hypoplastic muscle.
Dr. Barry Eppley
Indianapolis, Indiana