This syndrome, named after Sir Alfred Poland, is characterized by variable underdevelopment of the breast, nipple, chest muscles, ribs and upper extremity on the side of the body affected by this condition. Both men and women can be affected. In milder cases, one breast does not develop fully during puberty, and as a result, is generally smaller than the uninvolved breast and may not have a conventional shape. Males with mild cases may simply notice that their chest appears to be slightly concave on the involved side. In more severe cases, the breast, nipple/areola and even the pectoralis muscle may be completely absent. Women with mild cases may notice that the involved breast is significantly smaller than the other side; in more severe cases, the breast may be completely abscent. In the most severe cases, the skeletal structure of the chest (ribs and breastbone) and the arm may also be affected. Except in the most severe cases, most people do not have any functional disability from Poland’s Syndrome.
In order to correct these abnormalities in the appearance of the breast and chest, reconstructive surgery is commonly sought by both women and men affected by Poland’s Syndrome Female teenagers, typically, feel self-conscious, and may even experience intense anxiety as a result of abnormal or markedly assymetrical breast development. The type of surgery and the timing of such reconstructive surgery will depend on a number of factors including the person’s age and the severity of his or her condition.
Many different techniques have been used to correct these chest and breast abnormalities. Historically, tissue expanders, implants with or without latissimis dorsi muscle flaps, and TRAM muscle flaps are most commonly used to treat females with Poland’s Syndrome. Men have traditionally been treated with custom-fabricated implants and latissimis dorsi muscle flaps. While implant reconstruction is commonly suggested as a first step, the shortage of skin, breast tissue and sometimes muscle available to cover an implant makes achieving a satisfactory outcome with these procedures especially challenging.
Newer methods of reconstruction now offer people with Poland’s Syndrome the option of undergoing reconstruction of the breast and chest using their own tissue but without having to sacrifice important functional muscles like the latissimis dorsi or the rectus abdominis for a TRAM flap. Breast reconstruction using a perforator flap such as the DIEP flap, SIEA flap, or TDAP flap can help restore the contour of the chest and breast without the use of an implant or muscle. Autologous fat grafting may also be an option for both men and women who have only mild cases of Poland’s Syndrome. These reconstructive procedures may be an attractive option when an implant is not desired or when an implant has previously been ineffective.