Patient 6 Gallery

Before and after Poland Syndrome reconstruction in a 15-year-old girl with this rare congenital abnormality – a condition we see in patients every several years. Her right breast had not developed at all, with a small and highly located nipple and underlying rib deformities. She felt self-conscious changing in front of her classmates during PE and had to wear a prosthesis in her bra which made her self-conscious and prevented her from wearing shirts that did not have a high neckline.

Poland Syndrome is theorized to be due to in utero spasm of the subclavian artery during a particular time in a human baby’s development. This condition occurs both in males and females. Due to a temporary decreased blood flow, some of the downstream targets the subclavian artery system provides blood flow to do not develop completely, normally or sometimes at all. These anatomic structures include the sternal head of the pectoralis major muscle, the breast, nipple and sometimes the ribs, bones of the hand and other muscles in the region.

This patient has the classical stigmata of Polands Syndrome which include absence of the anterior axillary fold (seen as inward curvature of the armpit region on the affected side) and lack of development of the breast with a small and superiorly located nipple-areola complex.

Her breast reconstruction involved placement of permanent and postoperatively adjustable saline-filled breast implants beneath both breasts. The right side was inflated significantly during surgery to expand the breast envelope and recruit more breast skin into a natural breast shape. The left implant only needed to be filled a small amount at the time of surgery. These special implants allowed adjustment of the implant volume by adding or removing additional saline through the ports left under the skin just beside the breast as she continued to grow and develop physically and finish puberty.

Three and a half years after her first surgery when she had entered adulthood, she returned for removal of the implant ports and conversion to permanent silicone gel breast implants. She was given the option to keep her saline implants and just remove the implant ports but chose to have silicone implants to decrease the visibility of implant rippling through thin breast skin on the right side.

Bilateral areola tattoo created improved symmetry of the areola diameter. We discussed the option of moving her right nipple downward to better match the left side, but decided to leave the nipple alone since the nipple asymmetry did not bother her and to preserve the possibility of breast feeding in the future.

Follow up photos are shown 2 months after implant exchange and areola tattoo. The tattoo color and intensity are very bright and will fade naturally over time. She loves wearing lower necklines and she finally “feels normal”. We will continue to see her in long-term follow up every 10 years, or after other changes in her body like pregnancy or weight gain to monitor her symmetry as she continues to live her life!