It is usually considered a unilateral condition.

The cause of Poland syndrome is unknown. However, an interruption of the embryonic blood supply to the arteries that lie under the collarbone (subclavian arteries) at about the 46th day of embryonic development is the prevailing theory

These deficiencies are largely cosmetic, with the most common (simple) form presenting as a unilateral absence of the sternocostal head of the pectoralis major muscle. The deformity can also be complex, with ipsilateral absence of ribs, axillary webbing, and foreshortening of the hemithorax. The complex can also incorporate a variety of ipsilateral torso and upper extremity defects, including agenesis of the anterior portions of ribs two through five; derangement of the sternum; and absence of the latissimus dorsi, serratus anterior, and external abdominal oblique muscles. The breast tissues may be small or absent and the nipple-areola complex can be small, lightly pigmented, and displaced toward the axilla

Treatment

In female patients, mild cases may be satisfactorily treated with a mammary prosthesis. However, this option can accentuate subclavicular hollowing and, due to the natural tightness of the parasternal tissues, the implant may easily migrate into this space. This results in a high-riding, misshapen breast mound that is distressing. Additions to the mammary implant can include a customized chest wall implant, a TRAM flap, and/or a latissimus muscle transfer, all of which can provide shape and volume to the deficient upper chest wall. Fat grafting is as well a good tool to disguise the contour of the implant and get a better symmetry.

In male patients, the objective was to replace the missing pectoralis major, the better technique is to transfer the latissimus muscle to the chest. Although this is considered to be the best option most of patients do not accept to use a healthy muscle for that, so in mot of these cases we use a pectotal implant. The implant is turned clock or anticlockwise to mimick the healthy side and to recreate the contour of the pectoralis muscle. Fat grafting can be used to disguise the unavoidable edges od the implant that can be seen subcutaneously.

In complex casesin both sexes where there are missing ribs, the defect is treated with ribs and implants are not used because there is no a firm background. In these cases autologous tissues are the option of choice for reconstruction.

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The Symposium was quite interesting regarding the use of body implants, even though most of the lectures were focused on the breast ones. It was organized by Dr. Gabka from Munich (next to me in the pic) and Dr. Noah from Kassel, both members of the German Society for Aesthetic Plastic Surgery, to whom we should be grateful for properly moderating the various presentations, maintaining a strict schedule (something quite difficult to see over here…)

The first part of the morning session was devoted to the experience with MPS implants, i.e. micropolyurethane-covered implants (this cover is unique in that it adheres better to the surrounding tissue and reduces capsular contracture). The results presented by most authors were good and all agreed in highlighting as significant complications (although rare, with incidences of 2%) the presence of a rash (erythema or redness) and seroma. I especially liked the presentations of Dr. Dryuk (with his experience in the management of complications caused by the injection of BioAlcamid, quite common in the Eastern countries); Dr. Miró, a Brazilian surgeon with his experience on breast implants (most of subfascial position) and Dr. Brunnert on complication management.

The second part of the morning session was devoted to the use of anatomical implants in breast reconstruction. Nothing particularly new on this side. There was also a controversial presentation by Dr. Santos of Colombia, who combines both abdominoplasty and breast augmentation from the same abdomen dissection. Abdominoplasty results were very good, but it lacked definition in the inframammary fold. I think this technique is good in patients with small breasts, without ptosis, provided that afterwards you strenghthen the submammary fold with good suture.

In the afternoon, I’d like to highlight the presentation by Dr. Gabka on the use of a new acellular dermis for the resolution of problems in breast augmentation and reconstruction. It consists of a sheet obtained from human dermis that strengthens the implant’s cover, placing it between the muscle and the inframammary fold at the lower pole of the breast. It is also used in breast augmentation to hide the rippling (visible wrinkles in implants). At the moment, it is only available in Germany (and it’s quite expensive).

Dr. Stan presented very passionately the new implants of double gel of Polytech. These implants have two different gels, one more cohesive than the other, to better maintain the shape of the breast and give it more projection. As with polyurethane, the comfortable incision is the submammary (which may limit its applications depending on the patient). What’s left to investigate is the real differences with the Allergan’s 510 implant, which not long ago this doctor also defended with passion…

I closed the symposium with the presentations that I have mentioned before (and we’ll share in Slideshare). At least they were like a break after so much breast presentation and they showed different implant applications in an environment (Central Europe) quite unaccustomed to them.

Finally, we had to return to Barcelona by car (12 hours) due to airport closure by the activity of the unpronounceable volcano… How pricey science and keeping up-to-date is!

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Type: Press Release
Date: July, 2008
Topics: male aesthetic surgery, pect implants.

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