Breast reconstruction in Poland anomaly with endoscopically-assisted latissimus dorsi muscle flap and autologous fat tissue transfer: a case report and review of the literature.

OBJECTIVE: The breast deformity in females with Poland anomaly (Poland syndrome) can be particularly embarrassing from esthetic and social point of view. Various methods of breast reconstruction were reported comprising breast implants, latissimus dorsi (LD) flap or the combination of these two. The aim of this study was to present a breast reconstruction in Poland anomaly with endoscopically-assisted LD muscle flap in association with autologous fat tissue transfer and to analyse the results in the light of the literature data. PATIENTS AND METHODS: An 18-year-old woman presented with severe left breast hypoplasia (in the context of a Poland anomaly) with heavy social and psychological impact on both private and professional life. No thoracic deformity was clinically and radiologically detectable. The preoperative imaging studies of the breast (mammography and ultrasound) did not show any pathological findings. A three-stage autologous breast reconstruction was performed. An endoscopically assisted LD muscle flap was carried out during the first stage. This was followed by two stages of autologous fat tissue transfer and reduction mammaplasty of the opposite breast.
RESULTS: No postoperative complications were observed. The postoperative pain was less intensive than in the classic open technique. The LD muscle harvesting was carried out through a smaller incision which left a smaller back scar. The final result was breast symmetry of excellent quality.
CONCLUSIONS: The breast reconstruction in Poland anomaly can be performed with entirely autologous techniques. Endoscopic techniques in LD harvesting leave smaller scars and cause less postoperative pain. The autologous fat tissue transfer can be an useful adjunct to the classic flap techniques provided that safety requirements in technique and follow up are strictly observed.