Concurrent Poland’s syndrome and gynaecomastia: achieving the balance using lipomodelling

Abstract

The occurrence of both Poland’s syndrome and gynaecomastia in the same patient is extremely rare. This is only the second report in the medical literature. These distinct deformities of the chest wall have very different aetiologies. Poland’s syndrome is a heterogeneous congenital condition thought to be a consequence of a developmental hypoxic insult between 6 and 8 weeks of gestation as the upper limb and chest musculature develops. It encompasses a spectrum of congenital anomalies, characterised by hypoplasia or agenesis of the pectoralis muscles, breast, nipple areolar complex, soft tissue and upper limb skeletal anomalies. It is usually unilateral. Gynaecomastia by contrast is the benign enlargement of breast tissue in males. Aetiology in adult patients includes systemic disease, hormone imbalances and drugs, and may be unilateral or bilateral. We report the case of a 46-year-old man who presented with chest wall asymmetry. The Poland’s syndrome affecting his right chest had only become apparent with the development of a contralateral gynaecomastia. Surgery was performed with liposuction and nipple-preserving skin reduction of the gynaecomastia. The harvested fat from the breast was used with additional abdominal wall fat and transferred to the right chest defect caused by Poland’s syndrome. This is the first time that lipomodelling has been reported in the reconstruction of Poland’s syndrome using fat transferred from the contralateral breast.

Level of Evidence: Level V, therapeutic study.