RECONSTRUCTION OF BREAST ASYMMETRY IN POLAND CHEST-WALL DEFORMITY USING MICROVASCULAR FREE FLAPS

Poland's syndrome comprises a spectrum of chest-wall deformities affec ting, to various degrees, the rib cage, the chest-wall muscles, the ne urovascular structures of the ipsilateral arm, and the overlying breas t. This study details our experience with nine female Poland's syndrom e patients who had chest-wall and breast asymmetry corrected by microv ascular free-tissue transfer. Nine female patients with Poland's chest deformity underwent 12 microvascular free flaps between 1989 and 1994 . Donor sites for free-tissue transfer included eight transverse rectu s abdominis flaps, two superior gluteal flaps, one inferior gluteal fl ap, and one contralateral latissimus dor si flap. Recipient vessels we re branches of the subscapular vascular axis in all patients. Patients ' ages ranged from 18 to 47 years at the time of reconstruction. Chest -wall and breast asymmetry varied from accompanying severe pectus and rib cage deformities to isolated breast involvement. Complications wer e limited to a superior gluteal flap loss due to anomalous subscapular venous drainage. This patient underwent a successful second superior gluteal flap reconstruction utilizing the cephalic venous outflow syst em. Chest-wall and breast symmetry was restored in all patients. This study demonstrates that microsurgical reconstruction of chest-wall and breast asymmetry in Poland's syndrome yields excellent results with a high degree of patient satisfaction. Careful intraoperative assessmen t of the recipient vessels prior to flap transfer is mandatory. Becaus e Poland's chest-wall deformity may include anomalies of the vascular system, preoperative vascular assessment with duplex ultrasonography s hould be considered in all patients, and use of preoperative angiograp hy or venography in selected patients also appears justified.