Gary Rosenbaum, MD, and Robert J. Allen, MD.
Department of Plastic Surgery, Louisiana State University Medical Center, New Orleans.
The chest deformity of Poland's syndrome ranges from a paucity of breast tissue to an absence of rib and accompanying musculature. The majority of patients suffer more from the aesthetic appearance of the breast than from a functional handicap of the absent soft tissue.
Numerous approaches have been advocated for reconstruction of the breast mound and obliteration of the subclavicular hollow. These include implants, prosthetics, combination muscle flap and implant procedures, and muscle free flaps. Limited available soft tissue, the potential for foreign body complications, or loss of muscle function restricts these modalities.
A perforator free flap based on the superior gluteal artery was used for two patients with Poland's syndrome as a new procedure to reconstruct the hypoplastic or absent breast. The internal mammary vessels are used as recipient vessels. There is minimal donor defect with the scar hidden in the panty line. No muscle is sacrificed, there is no need for prosthetics, and the feel and contour of the donor tissue is similar to breast tissue. This provides the patient with a long-lasting autogenous reconstructive procedure with minimal chance for long-term complications.