Autologous Breast Reconstruction With Deep Inferior Epigastric Perforator Flap Reconstruction for Poland Syndrome

Poland syndrome is a disorder characterized by hypoplasia or absence of the pectoralis major, pectoralis minor, ipsilateral breast tissue, and associated excavatum deformities. The underlying mechanism of Poland syndrome is thought to be embryological abnormalities in the vasculature of the subclavian arteries and branches. Autologous breast reconstruction using free tissue transfer in female patients with Poland syndrome may still be achieved despite potentially anomalous vascular anatomy. We present a novel case of a 19-year-old female patient with right-sided Poland syndrome who underwent a successful 2-stage unilateral deep inferior epigastric perforator free flap reconstruction with an atypical substernal location of the internal mammary artery. Following free tissue transfer, the patient's native minimal breast parenchyma was mobilized on a superiorly based pedicle to further enhance the upper breast contour and improve symmetry. Autologous free flap reconstruction has been previously described for correcting breast asymmetry in patients with Poland syndrome. Microanastomosis using internal mammary vessels may be successfully performed in the presence of anatomic variants. Additionally, hypoplastic breast parenchyma can successfully be mobilized as an adjunct to free tissue transfer.