Reconstructive techniques for chest and breast deformities in Poland syndrome: An up-to-date systematic review

Poland syndrome (PS) is a congenital abnormality defined as aplasia or hypoplasia of the unilateral pectoralis muscle and breast tissue that may be accompanied by limb or thoracic deformities. Reconstruction of deformities associated with PS is challenging owing to the spectrum of differences. We aimed to evaluate the trends in surgical management of chest and breast anatomical anomalies associated with PS.

A systematic review of studies describing primary surgical management of chest and breast deformities in PS was conducted. Papers exclusively describing PS-associated hand reconstruction or intrathoracic surgeries were excluded.

Among the 741 articles, 77 met inclusion criteria. Flap-based reconstruction was used in 60.3% of cases, predominantly involving the latissimus dorsi muscle (60.3%). Tissue expanders were used in 22.5% of the patients, all of whom were women. Among them, 80.8% eventually underwent implant-based reconstruction. Among the male patients, flaps alone were the most common reconstructive modality (41.7%), whereas the predominant approach for women was hybrid reconstruction using flaps and implants (34.2%). In temporal analyses, the use of fat grafting, either alone or as an adjunct to other reconstructive techniques, has increased since the 1990s.

Reconstructive strategies employed in male and female patients with PS are varied, likely owing to the differences in the desired breast contour. There is no gold standard for the correction of chest and breast deformities associated with PS; however, new techniques such as fat grafting and hybrid reconstruction are gaining popularity as viable reconstructive options. We present a decisional framework to best address the varying anomalies associated with PS in men and women.