Congenital deformities involving the breast may be minimal, ranging from small nipple or nipple-like asymmetries and small volume asymmetries to important asymmetries of shape, volume and position of the breast in the chest wall. Even when the changes are small, they cause great suffering for the patients, requiring complex surgical corrections that treat the deformity with the smallest possible secondary sequel. Among the congenital syndromes involving the breast, Poland’s syndrome is the main one characterized by abnormalities of the breast and chest wall, vertebral abnormalities and deformities of the upper limb.
There are several theories about the cause of this syndrome, being attributed to changes in embryonic formation, genetic factors or hormonal deficiencies. The incidence is estimated at 1:25,000 to 1:32,000 births. The ratio between man and woman is 3:1, and 75% of patients have the right side affected.
The deformities of the chest wall are less apparent at birth than those of the hand and cause more discomfort to patients during adolescence, when the alteration is accentuated by the absence or asymmetry of breast development. In Poland´s syndrome, the absence or hypoplasia of the pectoral muscles provides poor coverage for the reconstruction of the breast with prosthesis, causing the deformity that most disturbs the patients: the skin fold in the anterior axillary pillar.
Several alternatives were proposed for the surgical treatment of these deformities with unsatisfactory results and important limitations. Tissue expander to expand the local skin and allow the placement of a prosthesis or the use of muscle or myocutaneous flaps, depending on the degree of deformity, can be used with the purpose of solving such problems, however they do not model the breast satisfactorily and leave important deformities in their retail donor areas. In addition, these surgical alternatives hardly offer a good aesthetic result.
Dr. Sirlei Costa published, in 1998, for the first time in the world literature, the use of the omentum flap dissected by videolaparoscopy to repair the deformities of the breast in the Poland syndrome. This technique is considered the best option for reconstruction of the breast with Poland syndrome, offering a very interesting aesthetic result.
The reconstructive surgery center in Porto Alegre-RS has a highly qualified surgical team familiar with this procedure and, as an international reference in the treatment of this pathology, has received patients from many parts of the world.
The use of transposition of the omentum flap dissected by videolaparoscopy, to reconstruct the most frequent deformities caused by this syndrome, allows a better contour of the breast, redoing the anterior axillary pillar and filling the infraclavicular depression. It also leaves the prosthesis better covered and less apparent, obtaining better symmetry with the opposite hemithorax. In addition, the use of videolaparoscopy makes the procedure less aggressive and no additional deformities of the tissue donor zone are necessary.
Learn more in the article on Poland´s Syndrome authored by Dr. Sirlei Costa.