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Poland syndrome is a well known chest wall deformity that always has some degree of underdevelopment of the pectoralis muscle. With the muscle deformity displacement of the nipple superiorly usually occurs as well potential underlying ribcage abnormalities. Many variations in the expression of Poland syndrome occur with other potential deformities of the shoulder, arm and hand in more severe cases. It is more commonly seen in men and more often the right side of the body.

In the aesthetic treatment of Poland syndrome the fundamental concept is to restore volume to the pectorals muscle. While once done by muscle transfers, this approach is often viewed as too aggressive, causing its own aesthetic tradeoffs, and the most treatment approach today is often tried with fat grafting. But fat grafting is highly variable and often either doesn’t take well or ends up creating more of a breast mound than a more apparent pectoral muscle definition.

In the August 2018 issue of the journal Plastic and Reconstructive Surgery a paper was published entitled ‘ Correcting Poland Syndrome with a Custom-Made Silicone Implant: Contribution of Three-Dimensional Computer-Aided Design Reconstruction’. In his paper the authors reviewed their twenty-five (25) year experience in treating one hundred twenty-nine (129) Poland syndrome patients using a silicone implant. While initially making the implants from plaster molds, a computer design method has been used for the past ten years. Fat grafting by injection was concurrently performed in one-third (42) of the patients. Breast implants were used in almost one-quarter of the patients.

They judged the cosmetic outcome as excellent in 90% of the cases with 80% of the patients being satisfied or very satisfied. Complications included infection in 2 cases (1.5%) and exposed implants in 3 cases. (2%) A Medical Outcomes Study showed significant improvements in emotional well-being and social functioning.

The use of implants for many forms of chest wall reconstruction is not new and they are more likely to create the appearance of a muscle if properly designed. It is hard to argue that a computer-based design would not create a superior implant shape using the opposite normal side as a mirror shape goal. But when an implant of any size is placed where there is thin soft tissue cover (no muscle and only skin and subcutaneous fat layer) there is always going to be concerns and the real potential for complications.

This clinical study shows a remarkably low occurrence of such complications and a high rate of patient satisfaction as a reflection of both low rate of postoperative problems its success in creating improved albeit to perfect chest wall symmetry. The authors have also correct pointed out that aesthetic revisions of the implant do occur as well as the need for adjunctive procedures to optimize the result.

Dr. Barry Eppley

Indianapolis, Indiana

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