Poland Syndrome

What Is Poland Syndrome? Information on Chest Muscle, Breast, Rib, and Hand Findings; Diagnosis, Fat Grafting, Implant, and Reconstruction Options.
Poland syndrome is a congenital developmental condition characterized by underdevelopment or complete absence of part of the pectoralis major muscle on one side of the chest. The most commonly affected structure is the sternocostal portion of the pectoralis major muscle, which attaches to the sternum and ribs. Some people have only a mild asymmetry of the chest muscle. Others may also have additional structural differences on the same side. These may include:
  • Underdevelopment of the pectoralis minor muscle
  • Rib or costal cartilage anomalies
  • A depression in the chest wall
  • Underdeveloped breast tissue
  • A small, absent, or displaced nipple or areola
  • A flattened anterior axillary fold
  • Developmental differences in other chest or shoulder muscles
  • Arm or forearm asymmetry
  • Hand and finger anomalies
Poland syndrome usually affects one side of the body. It is more common on the right side but can also occur on the left. Involvement of both sides is rare. The extent of the findings varies considerably from person to person.
Mild cases may not be noticed until adolescence or adulthood. The difference between the right and left sides may become more noticeable, particularly as muscle or breast development progresses. More extensive cases may be recognized in childhood because of differences in the chest wall, upper limb, or hand. Not every case of Poland syndrome needs to be treated or operated on. The evaluation considers the following together:
  • Which muscles are affected
  • The structure of the ribs and chest wall
  • The structural stability of the rib cage
  • Breast and nipple development
  • Hand and upper limb function
  • Age and whether growth is still ongoing
  • Physical complaints
  • Psychosocial impact
  • The person's expectations

What Is Poland Syndrome?

The pectoralis major is the large muscle that covers the upper front of the chest. This muscle contributes to:
  • Bringing the arm toward the body
  • Moving the arm forward
  • Internal rotation of the shoulder
  • Pushing movements
  • Forming the anterior axillary fold
  • Shaping the outer contour of the chest
In Poland syndrome, the sternocostal portion of the pectoralis major muscle in particular is underdeveloped or absent. The clavicular portion of the muscle, near the collarbone, may be preserved. In some people, a larger portion or nearly all of the pectoralis major muscle may be affected. On the same side, the following may also be underdeveloped or smaller than normal:
  • Pectoralis minor
  • Serratus anterior
  • Latissimus dorsi
  • Intercostal muscles
  • Other shoulder girdle muscles
The core clinical feature of Poland syndrome is a one-sided developmental deficiency of the sternocostal portion of the pectoralis major muscle. Hand anomalies may be associated with Poland syndrome but do not occur in every patient. Likewise, the absence of obvious breast, nipple, or rib anomalies does not rule out Poland syndrome.

What Causes Poland Syndrome?

The exact cause of Poland syndrome is not fully known. One proposed mechanism is a temporary disruption of blood flow in the vessels supplying the structures around the chest and shoulder during early development in the womb. This developmental change may affect the following to varying degrees:
  • Chest muscles
  • Ribs and costal cartilages
  • Breast tissue
  • Shoulder and upper limb structures
  • Hand and fingers
This vascular development theory is one of the most frequently discussed explanations for Poland syndrome, but it is not a proven mechanism that definitively explains every case. Poland syndrome is not caused by:
  • Something the mother did during pregnancy
  • The child's sleeping position
  • Playing or not playing sports
  • Poor nutrition
  • Wearing tight clothing
  • Carrying something heavy
  • A mistake made by the child or the family

Is Poland Syndrome Hereditary?

Most people with Poland syndrome have no other affected family members. The large majority of cases occur sporadically. Although cases with more than one affected person in the same family have been reported, they are uncommon. No single genetic change has been identified that explains all cases of Poland syndrome. Genetic evaluation may be considered particularly when:
  • Several family members have similar findings
  • Involvement of both sides is suspected
  • Multiple congenital anomalies are present together
  • Growth or developmental problems are also present
  • Another genetic syndrome is suspected
A normal genetic test result does not rule out Poland syndrome.

How Common Is Poland Syndrome?

Poland syndrome is a rare congenital condition. Its true frequency is difficult to determine because mild cases may go unnoticed for many years. The condition is sometimes recognized when:
  • The chest muscles develop differently during adolescence
  • Breast asymmetry becomes more noticeable
  • A difference between the right and left chest is noticed during sports
  • Missing muscle is seen on imaging performed for another reason
  • An adult is evaluated for chest asymmetry
For this reason, the number of diagnosed cases may be lower than the true frequency.

Which Side Does Poland Syndrome Affect?

Poland syndrome is usually one-sided. The right side is affected more often, but left-sided Poland syndrome can also occur. On the affected side, the following may be involved to varying degrees:
  • Pectoralis muscles
  • Breast tissue
  • Nipple and areola
  • Ribs and cartilage structures
  • Shoulder muscles
  • Arm and forearm
  • Hand and fingers
Not all of these structures need to be affected in the same person. One patient may be missing only part of the pectoralis major muscle, while another may have muscle, breast, rib, and hand anomalies together.

What Are the Symptoms of Poland Syndrome?

The appearance of Poland syndrome can range from mild chest asymmetry to more extensive differences in the chest wall and upper limb. Possible findings include: Reduced muscle volume on one side of the chest A marked difference in volume between the right and left chest A flattened anterior axillary fold Underdeveloped breast tissue A small or displaced nipple Areolar differences A depression in the chest wall Rib or costal cartilage anomalies Shoulder asymmetry A thinner arm or forearm A smaller hand Short fingers Webbing (fusion) between fingers Asymmetric chest movement Reduced strength in certain shoulder movements Psychosocial effects related to body image The degree of physical and functional impact depends on which structures are affected.

Is the Pectoralis Major Muscle Completely Absent?

No. There is no rule that the entire pectoralis major muscle is missing in every patient with Poland syndrome. The most commonly affected part is the sternocostal portion. The clavicular portion may be preserved. When part of the muscle is present, shoulder and arm movements may be normal or near normal in daily life. In more extensive cases, the following may also be affected:
  • The entire pectoralis major muscle
  • Pectoralis minor
  • Serratus anterior
  • Latissimus dorsi
  • Intercostal muscles
Determining which muscles are present is important for reconstruction planning. For example, if the latissimus dorsi muscle is markedly underdeveloped, it may not be possible to use it as a standard muscle flap.

What Does Chest Asymmetry Look Like?

The appearance of the chest varies with anatomy, sex, body fat percentage, and breast development. In males, the following may be seen:
  • Reduced muscle volume on one side of the chest
  • A depression around the nipple
  • A flattened anterior axillary fold
  • More visible rib contours
  • Asymmetry that becomes more noticeable when the muscle contracts
  • A right-left difference that increases after intensive muscle building
In females, the following may be more noticeable:
  • One breast being less developed
  • A smaller or narrower breast base
  • A nipple in a different position
  • An inframammary fold at a different level
  • A depressed chest wall beneath the breast
  • Thinner soft tissue
  • Asymmetry in breast volume and position
The asymmetry in Poland syndrome may not come from a single tissue layer alone. Differences in muscle, bone, cartilage, breast tissue, fat, and skin may all be present together. For this reason, a single implant or a single surgical technique cannot always correct the entire deformity.

Can the Breast and Nipple Be Affected?

Breast tissue on the affected side may be smaller than normal or markedly underdeveloped. Possible findings include:
  • Breast hypoplasia
  • Marked lack of breast tissue
  • A narrow breast base
  • An inframammary fold at a different level
  • A small nipple
  • A displaced nipple
  • A small areola
  • Rarely, absence of the nipple-areola complex
  • Thin or tight skin and soft tissue coverage
Breast development continues throughout puberty. For this reason, remaining growth is taken into account when permanent breast reconstruction is planned. In selected adolescents with marked asymmetry and significant psychosocial impact, staged approaches may also be considered.

Why Can the Anterior Axillary Fold Be Flattened?

If this part of the muscle is underdeveloped, the front border of the armpit may look flatter or less defined. This difference may become more noticeable particularly:
  • When the arms are raised
  • During exercise
  • When the pectoralis muscle contracts
  • When wearing tight clothing
  • In people with low body fat
An implant can increase chest volume but cannot always recreate the anterior axillary fold with its natural anatomy. For this reason, the following may be considered in some patients:
  • A custom implant
  • Fat grafting
  • Muscle or fascial tissue
  • Local tissue rearrangement
  • A combination of several techniques
The anterior axillary fold is formed largely by the outer edge of the pectoralis major muscle.

Can the Ribs and Chest Wall Be Affected?

Some patients with Poland syndrome may have rib or costal cartilage anomalies. These may include:
  • Underdeveloped costal cartilages
  • Partial absence of the front portion of one or more ribs
  • A depression in the chest wall
  • Rotation of the sternum
  • Rib cage asymmetry
  • Reduced structural support in a particular area
  • Abnormal chest movement during breathing
Not every rib anomaly causes breathing problems. However, in advanced and extensive chest wall defects, the mechanical stability of the rib cage and protection of the internal organs may become the priority. In such cases, soft tissue reconstruction aimed only at correcting the outer contour is not sufficient.

Can the Hand and Fingers Be Affected?

In Poland syndrome, there may be developmental differences in the hand and fingers on the same side. These may include:
  • Short fingers
  • A smaller hand
  • Webbing (fusion) between fingers
  • Short or underdeveloped finger bones
  • Greater involvement of certain fingers
  • Differences in forearm or arm development
  • Reduced grip strength
  • Difficulty with fine motor movements
Short fingers are called brachydactyly, and webbing between the fingers is called syndactyly. The severity of the hand findings does not always parallel the severity of the chest findings. When hand function is affected, a hand surgery evaluation can help plan the appropriate timing of treatment.

Is Shoulder and Arm Function Affected?

The pectoralis major contributes to certain shoulder and arm movements. Many people who are missing only a specific part of the muscle may have no noticeable loss of function in daily life. Some people, however, may have:
  • Reduced strength in pushing movements
  • Weakness in bringing the arm toward the body
  • Early fatigue around the shoulder
  • Difficulty with activities such as swimming or climbing
  • A right-left difference during weight training
  • Changes in shoulder blade movement
  • Shoulder discomfort
Involvement of other shoulder girdle muscles may increase the functional difference.

Does Poland Syndrome Affect the Heart or Lungs?

Serious heart or lung involvement is generally not expected in mild Poland syndrome. However, with more extensive rib or chest wall defects, the following may occur:
  • Reduced chest wall support during breathing
  • Differences in chest movement
  • Changes in breathing mechanics
  • Less protection of the underlying lung tissue
Rarely, other congenital internal organ anomalies may accompany Poland syndrome. For this reason, additional tests are not applied the same way to everyone; they are selected based on clinical findings and complaints.

Can Poland Syndrome Have Psychological Effects?

Differences in the appearance of the chest, breast, nipple, or hand can affect body image. Some people may:
  • Avoid changing clothes in front of others
  • Not want to take part in pool or beach activities
  • Feel uncomfortable at the gym
  • Avoid tight clothing
  • Stand hunched forward to hide their chest
  • Feel anxious in social or romantic relationships
  • Avoid certain angles in photographs
The degree of psychosocial impact does not always parallel the size of the anatomical difference. Body image is a valid part of the treatment evaluation, but it should not be assumed that reconstruction will resolve all issues with self-confidence or body image.

How Is Poland Syndrome Diagnosed?

The diagnosis is usually made through medical history and physical examination. The key finding is an underdeveloped or absent sternocostal portion of the pectoralis major muscle on one side of the chest. The examination may assess:
  • Chest muscle volume
  • The appearance of the muscles during contraction
  • The anterior axillary fold
  • Breast development
  • Nipple and areola
  • Chest wall contour
  • Rib structure
  • Shoulder and shoulder blade movement
  • Arm and forearm size
  • Hand and finger structure
  • Scoliosis
  • Chest movement during breathing
  • Previous surgeries
Resisted arm or shoulder movements may be used to make the muscle difference more visible.

Can Ultrasound Be Used?

Ultrasound can help evaluate the superficial chest wall muscles. With this method, the following can be examined:
  • Which parts of the pectoralis major muscle are present
  • Muscle thickness
  • Pectoralis minor
  • The muscle difference between the two sides
  • Superficial soft tissues
Ultrasound does not involve ionizing radiation. It can be particularly useful in children or when the physical examination needs anatomical confirmation. Imaging is not mandatory in every typical case of Poland syndrome.

When Can Computed Tomography Be Used?

Computed tomography can show the bone and soft tissue anatomy of the rib cage in detail. It may be considered particularly in cases of:
  • Suspected missing ribs
  • A marked structural chest wall defect
  • Rotation of the sternum
  • Suspected outward bulging of lung tissue through a weak area
  • Complex chest anatomy
  • Planning of chest wall reconstruction
  • Planning of a custom implant
  • Previous chest wall surgery
CT can provide information about muscle, rib, and cartilage structures and the deeper anatomy of the chest wall. Because it involves ionizing radiation, it should be used, especially in children, only when clinically necessary.

Can Magnetic Resonance Imaging Be Used?

MRI can evaluate muscle and other soft tissues without using ionizing radiation. MRI can examine:
  • The pectoralis muscles
  • Latissimus dorsi
  • Other shoulder girdle muscles
  • Breast tissue
  • Subcutaneous fat
  • Previous implants
  • Selected vascular and nerve structures
It can be especially helpful in determining whether a muscle being considered for use in reconstruction is present.

What Is Three-Dimensional Imaging Used For?

Three-dimensional imaging and computer-assisted planning can help model chest asymmetry. During planning, the following may be used:
  • Computed tomography data
  • Three-dimensional surface scans
  • A mirror image of the unaffected side
  • Rib and chest wall contours
  • Volume differences
These methods can help with:
  • Measuring an irregular chest wall defect
  • Designing a custom implant
  • Planning selected structural reconstructions
  • Modeling the difference between the affected and unaffected sides
The term “3D implant” does not necessarily mean that the implant is produced in its final form directly by a 3D printer. In many applications, three-dimensional computer design is used to determine the shape of the implant, and the final medical product is manufactured using different production methods.

Is Genetic Testing Needed?

There is no single, standard genetic test that confirms Poland syndrome. Typical one-sided hypoplasia or absence of the sternocostal portion of the pectoralis major is usually recognized clinically. Genetic evaluation may be considered when:
  • Other family members are affected
  • Findings on both sides are suspected
  • Multiple congenital anomalies are present together
  • Developmental problems are also present
  • Another genetic syndrome is being considered

How Is the Severity of Poland Syndrome Determined?

There is no standard method that classifies Poland syndrome in all patients with a single number or index. Each structure is evaluated separately. These include:
  • Pectoralis major
  • Other chest and shoulder muscles
  • Ribs and sternum
  • Chest wall stability
  • Breast tissue
  • Nipple and areola
  • Skin and fat tissue
  • Hand and fingers
  • Shoulder and arm function
  • Heart and lung findings, when necessary
  • Psychosocial impact
In mild cases, there may be only a limited muscle deficiency, and function may be fully or largely preserved. In more advanced cases, muscle, breast, and soft tissue deficiencies may be seen together. In the most extensive cases, rib anomalies, chest wall stability problems, and upper limb differences may also be present. Defining severity helps with treatment planning but does not by itself determine whether surgery is needed.

Does Every Case of Poland Syndrome Need Treatment?

No. Mild chest asymmetries that do not significantly affect a person's function or psychosocial life can be monitored. When treatment is considered, the following are taken into account:
  • Physical function
  • Structural safety of the chest wall
  • Breathing mechanics
  • Hand function
  • Pain
  • Body image
  • Age and growth
  • The person's informed wish for treatment
It is important for children and adolescents to take as active a part as possible in treatment decisions.

How Is Treatment Planned in Poland Syndrome?

There is no single standard operation that can be applied to everyone with Poland syndrome. Treatment is determined by which tissues are missing or underdeveloped. The following questions are important in the evaluation:
  • Is the deficiency limited to muscle volume only?
  • Is there a rib or cartilage defect?
  • Is the chest wall stable?
  • Is breast development complete?
  • How have the nipple and areola developed?
  • Is there enough skin and fat tissue?
  • Can the latissimus dorsi be used?
  • Is hand or shoulder function affected?
  • Is growth still ongoing?
  • Is the expected result realistic?
Treatment options may include:
  • Monitoring
  • Physical therapy
  • Hand surgery
  • Fat grafting
  • Standard implants
  • Custom chest implants
  • Breast reconstruction
  • Tissue expander
  • Latissimus dorsi muscle transfer
  • Free tissue transfer
  • Nipple and areola reconstruction
  • Structural chest wall reconstruction in selected patients
Several methods may be used together or in stages.

What Is the Best Age for Treatment?

There is no single ideal age for every patient with Poland syndrome. Procedures to improve hand function may be performed in childhood. When permanent chest or breast reconstruction is planned, however, remaining growth is taken into account. Placing a permanent implant during childhood may lead to a new volume mismatch as the body continues to grow. Earlier structural intervention may be considered in selected situations such as:
  • Marked chest wall instability
  • Inadequate protection of lung tissue
  • Impaired breathing mechanics

Can Exercise and Physical Therapy Correct Poland Syndrome?

Exercise cannot rebuild a pectoralis major muscle that is congenitally missing. However, physical therapy and exercise can:
  • Maintain shoulder range of motion
  • Improve shoulder blade control
  • Strengthen the existing back and shoulder muscles
  • Improve posture
  • Reduce muscle imbalance
  • Support athletic movements
  • Improve overall fitness
Many people continue an active life and sports despite Poland syndrome.

Hand Surgery and Rehabilitation

If syndactyly, short fingers, or other structural hand differences affect function, hand surgery may be considered. The aim of treatment is to support:
  • Separation of the fingers
  • Grip function
  • Independent finger movement
  • Preservation of function during growth
  • Everyday use of the hand
After surgery, hand therapy, splinting, range-of-motion exercises, and scar management may be needed.

What Is Fat Grafting?

In fat grafting, fat tissue taken from the person's own body is transferred to areas of volume deficiency in the chest or breast. Fat may be taken from areas such as:
  • Abdomen
  • Waist
  • Hips
  • Thighs
Fat grafting may be used for:
  • Reducing mild chest asymmetry
  • Increasing breast volume
  • Softening implant edges
  • Supporting the anterior axillary fold
  • Increasing soft tissue thickness
  • Contour refinement of previous reconstructions
Not all of the transferred fat survives permanently. Because some of it may be absorbed over time, more than one procedure may be needed.

Risks and Limitations of Fat Grafting

Fat grafting may not fully correct a large muscle or skeletal deficiency in a single session. The result depends on:
  • The amount of available donor fat
  • Soft tissue quality
  • Blood supply to the area
  • The amount of fat transferred
  • How much of the fat is retained permanently
Possible risks include:
  • Partial fat loss
  • Asymmetry
  • Fat necrosis
  • Firmness
  • Oil cysts
  • Infection
  • Contour irregularity
  • Irregularity at the fat harvest site
  • Need for additional procedures
If fat grafting has been performed in the breast area, the radiology team should be informed of this during future breast imaging.

Can Standard Chest or Breast Implants Be Used?

They can be used in selected patients. In women, a breast implant can increase the volume of an underdeveloped breast. In men, a standard pectoral implant can partially mimic the volume created by the chest muscle. However, Poland syndrome often creates an irregular tissue deficiency that does not fully match standard implant shapes. The deficiency may be located:
  • Next to the sternum
  • Over the rib surface
  • At the anterior axillary fold
  • At the breast base
  • In more than one anatomical plane
For this reason, a standard implant may be sufficient in some patients but may not fully address the contour deficiency in others.

What Is a Custom 3D-Designed Implant?

A custom chest implant is an implant designed on a computer according to the patient's chest wall anatomy. Computed tomography or three-dimensional surface images may be used for the design. The shape of the missing volume can be estimated by mirroring the contour of the unaffected side onto the opposite side on the computer. The implant can be designed to support:
  • The missing pectoralis major contour
  • The depression next to the sternum
  • Differences in rib contour
  • The anterior axillary fold
  • Irregular areas that standard implants do not address
A custom design can help achieve a better-matched contour, particularly in irregular anatomical deficiencies. However, a custom implant is not the standard option for every patient with Poland syndrome, nor is it superior to other methods in every case. The method is chosen according to the patient's anatomy.

Is a “3D Implant” Produced Directly by a 3D Printer?

Not always. Three-dimensional technology is often used to design the shape of the implant on a computer. The process may include the following stages:
  • Three-dimensional imaging
  • Computer-assisted modeling
  • Calculation of the missing volume
  • Virtual implant design
  • Manufacturing the medical implant using an appropriate production method
The final implant may be made from different materials suitable for medical use.

Does a Custom Implant Restore Muscle Function?

No. A custom implant aims to mimic the volume and outer contour that the missing muscle would create. It is not living muscle tissue. Therefore, it:
  • Does not contract
  • Does not move the arm
  • Does not generate muscle strength
  • Does not grow with exercise
  • Does not restore the physiology of the missing pectoralis major
Its main purpose is to reduce asymmetry in the chest contour. Functional problems need to be evaluated separately.

What Are the Risks of a Custom Implant?

Possible complications include:
  • Bleeding
  • Hematoma
  • Seroma
  • Infection
  • Wound healing problems
  • Implant displacement
  • Visible implant edges
  • Contour irregularity
  • Capsular contracture
  • Firmness
  • Pain or discomfort
  • Skin thinning
  • Persistent asymmetry
  • Repositioning of the implant
  • Removal or replacement of the implant
  • Late fluid collection
A custom design can improve anatomical fit but does not eliminate the general surgical risks associated with implants.

What Is Structural Chest Wall Reconstruction?

A small group of patients with Poland syndrome may have significant rib deficiencies or a structurally weak chest wall. In this situation, soft tissue implants used only to correct the outer appearance or muscle volume are not sufficient. In structural chest wall reconstruction, the following may be used in selected cases:
  • Rigid support systems
  • Titanium or similar plates
  • Surgical mesh
  • Bone or rib grafts
  • Patient-specific structural implants
The goal here is not to mimic the appearance of the pectoralis muscle but to provide chest wall stability and protection of the internal structures.

When Might Chest Wall Reconstruction Be Needed?

Structural reconstruction may be considered in cases of:
  • Significant rib deficiency
  • Outward bulging of lung tissue through a weak chest wall
  • Abnormal chest wall movement
  • Inadequate protection of the internal organs
  • Marked rib cage instability
  • Severe structural asymmetry of the thorax
  • Significantly impaired breathing mechanics
In these patients, structural safety and function take priority over outward appearance.

What Is a Latissimus Dorsi Muscle Flap?

The latissimus dorsi is one of the large muscles of the back. In selected patients, it can be moved to the front of the chest while preserving its blood supply. This method may be used to:
  • Bring living tissue to the pectoral region
  • Support the anterior axillary fold
  • Increase soft tissue coverage
  • Provide coverage over a breast or chest implant
  • Contribute to breast reconstruction
Depending on the volume needed, it may be combined with an implant or fat grafting.

What Are the Limitations of the Latissimus Dorsi Flap?

This method creates a second surgical site on the back. Possible effects include:
  • A scar on the back
  • Seroma
  • Bleeding
  • Infection
  • Temporary limitation of shoulder movement
  • Strength differences in certain activities
  • Changes in back contour
  • Reduction in transferred muscle volume over time
  • Chest asymmetry not being fully eliminated
In addition, the latissimus dorsi muscle itself may be underdeveloped in some patients with Poland syndrome. For this reason, the presence and quality of the muscle should be evaluated before transfer.

What Is Free Tissue Transfer?

In free tissue transfer, living tissue taken from another part of the body is transferred to the chest using microsurgery. The tissue may be taken from:
  • The abdomen
  • The thigh
  • Other suitable donor sites
This method may be considered particularly:
  • When there is a large soft tissue deficiency
  • When breast development is markedly insufficient
  • When there has been a previous implant complication
  • In selected cases where a permanent implant is not desired
  • When sufficient donor tissue is available
Using living tissue may offer advantages, but the surgery is longer and more complex and creates a permanent donor site elsewhere on the body.

Breast Reconstruction in Women

In Poland syndrome, breast reconstruction may involve more than a standard breast augmentation. The asymmetry may result from several structures, such as:
  • Pectoralis muscle deficiency
  • Insufficient breast tissue
  • A small breast base
  • Chest wall depression
  • Thin soft tissue coverage
  • Differences in the inframammary fold
  • Nipple and areola anomalies
  • Absence of the anterior axillary fold
Treatment may use:
  • Fat grafting
  • Tissue expander
  • Breast implant
  • Custom chest implant
  • Latissimus dorsi flap
  • Free tissue transfer
  • Nipple and areola reconstruction
  • Surgery on the opposite breast in selected cases
Treatment may be carried out in one or more stages.

What Is a Tissue Expander?

A tissue expander is a temporary inflatable implant used to gradually stretch the skin and soft tissue over time. It may be used particularly when:
  • Soft tissue coverage is limited
  • The breast base is narrow
  • There is not enough space for a permanent implant
  • Breast development is markedly insufficient
It is expanded in a controlled way at regular intervals and later replaced with a permanent reconstruction.

Does the Opposite Breast Also Need a Procedure?

Not always. In some patients, procedures such as the following may be performed on the unaffected breast to improve overall symmetry:
  • Reduction
  • Lift
  • Augmentation
  • Adjustment of the inframammary fold
However, this intervention is not mandatory. Because the natural breast changes with age, weight, and pregnancy while the reconstructed side may change differently, perfect and lifelong stable symmetry cannot be guaranteed.

Nipple and Areola Reconstruction

The nipple and areola may be small, displaced, or, less commonly, completely absent. Reconstruction may use:
  • Local skin techniques
  • Medical pigmentation (tattooing)
  • Selected tissue transfers
  • Skin grafts
  • A combination of several methods
These procedures are usually planned after the main breast or chest volume has been created.

Chest Reconstruction in Men

In men, the main goal is usually to make the chest contour formed by the pectoralis major muscle and the anterior axillary fold more balanced. Options may include:
  • Custom pectoral implant
  • Standard pectoral implant
  • Fat grafting
  • Latissimus dorsi transfer
  • Implant combined with fat grafting
  • Structural chest wall reconstruction in selected advanced cases
In muscular people with low body fat, the edges of the implant may be more visible. Because the reconstructed side does not grow with exercise like a natural pectoralis muscle, intensive muscle building may make the asymmetry noticeable again over time.

Can Reconstruction Be Completed in a Single Operation?

In some limited deformities, a single procedure may be sufficient. In more complex cases of Poland syndrome, however, reconstruction may be planned in stages from the outset. The stages may include:
  • Structural chest wall reconstruction
  • Tissue expansion
  • Muscle or free tissue transfer
  • Permanent implant
  • Fat grafting
  • Nipple and areola reconstruction
  • Symmetry procedures on the opposite side, when needed
Needing more than one operation does not mean the previous operation failed.

Evaluation Before Reconstruction

Before surgery, the following may be evaluated:
  • The extent of muscle deficiency
  • Rib and sternum anatomy
  • Chest wall stability
  • Breast and nipple development
  • Skin and fat tissue thickness
  • The condition of the latissimus dorsi muscle
  • Shoulder and arm function
  • Hand anomalies
  • Remaining growth
  • Previous surgeries and scars
  • General health
  • Smoking
  • Current medications
  • Implant or metal sensitivity
  • The person's expectations
Three-dimensional computer modeling can help in understanding the treatment plan but does not guarantee that the postoperative appearance will be exactly the same.

What Are the General Risks of Reconstruction?

Risks vary depending on the method used. Possible complications include:
  • Bleeding
  • Hematoma
  • Seroma
  • Infection
  • Wound healing problems
  • Noticeable scarring
  • Changes in sensation
  • Persistent pain
  • Incomplete correction of asymmetry
  • Contour irregularity
  • Implant displacement
  • Capsular contracture
  • Partial loss of fat tissue
  • Flap circulation problems
  • Pneumothorax
  • Chest wall or lung injury
  • Need for additional surgery
  • Anesthesia complications
The smallest incision or the shortest operation is not automatically the most appropriate reconstruction for every patient.

Implant Infection

Infection may develop around an implant in the early or late period. Possible signs include:
  • Fever
  • Redness
  • Swelling
  • Discharge
  • Increasing pain
  • Change in chest contour
  • Fluid around the implant
In deep implant infections, the implant may need to be removed.

What Is a Seroma?

A seroma is a collection of fluid in the surgical area after an operation. It may occur particularly after operations in which a large surgical pocket is created, an implant is used, or a muscle flap is performed. Some seromas resolve on their own, while others may require drainage or additional treatment. A new fluid collection appearing around an implant in the late period should be evaluated separately.

What Is Capsular Contracture?

The body naturally forms a thin layer of connective tissue around an implant. If this tissue becomes markedly thickened and tight, capsular contracture may develop. This can result in:
  • Firmness
  • Pain
  • Change in chest shape
  • Change in implant position
  • Increased asymmetry
Using a custom implant does not completely eliminate the risk of capsular contracture.

Does the Implant Need to Be Replaced?

No implant can be guaranteed never to require any intervention over a lifetime. The 3D TELOMER SILICONE IMPLANTS we use are lifelong and do not need to be replaced. For standard breast silicone implants, please note the details below.

An implant may later be removed or replaced because of:
  • Infection
  • Displacement
  • Capsular contracture
  • Pain
  • Contour change
  • Damage
  • Late fluid collection
  • Changes in body shape
  • A change in reconstruction preference
However, there is no universal rule that all implants must be routinely replaced at a specific time.

Recovery After Surgery

Recovery time varies considerably depending on the procedure performed. Recovery after limited fat grafting is not the same as after muscle transfer, microsurgery, or structural chest wall reconstruction. In the early period, the following are important:
  • Pain control
  • Drain monitoring
  • Wound care
  • Maintaining shoulder movement
  • Breathing exercises
  • Early walking
  • Assessment of the implant or transferred tissue
Swelling and bruising can be expected in the early period. The final chest contour should not be judged until the tissues have healed and the swelling has subsided.

Activity After Surgery

The following may be temporarily restricted:
  • Heavy lifting
  • Forceful pushing or pulling
  • Strenuous overhead movements
  • Lying face down
  • Direct pressure on the chest
  • Contact sports
  • Activities with a risk of impact to the chest
  • Heavy upper body exercises
Complete immobility is generally not the goal. The movement program is tailored to the reconstruction performed.

Returning to Sports

Return to sports is gradual. It may begin with walking and light daily activities in the initial period. Later, the following may be added:
  • Light cardio
  • Shoulder mobility work
  • Controlled strengthening
  • Posture exercises
  • Shoulder blade stabilization
For contact sports and heavy upper body exercises, healing of the chest wall, the implant, and any muscle transfer is taken into account.

Does Poland Syndrome Prevent Pregnancy?

Poland syndrome alone does not prevent pregnancy. During pregnancy, the following may change:
  • Breast volume
  • Skin tension
  • Body weight
  • Chest and breast symmetry
For this reason, plans for a future pregnancy may affect the timing of some breast reconstructions.

Is Breastfeeding Possible With Poland Syndrome?

The ability to breastfeed depends on individual breast anatomy. Important factors include:
  • Glandular breast tissue on the affected side
  • Development of the milk ducts
  • Nipple anatomy
  • Previous surgeries
Even if milk production in the affected breast is limited, breastfeeding from the other side alone may be possible if that breast has developed normally. The presence of an implant alone does not determine whether breastfeeding is possible or impossible.

Is Complete Symmetry Achieved After Reconstruction?

Reconstruction can significantly reduce the difference in the chest, breast, or anterior axillary fold. However, perfect and lifelong unchanging symmetry cannot be guaranteed. Over time, the following may affect how the asymmetry looks:
  • Rib and sternum anatomy
  • The missing muscle
  • Skin thickness
  • Breast development
  • Weight changes
  • Pregnancy
  • Aging
  • Muscle development on the unaffected side
  • The fixed volume of the implant
  • Partial loss of fat tissue
  • Volume changes in transferred tissue
The goal is not to eliminate the anatomical difference completely but to create the most balanced result possible for the person's anatomy.

Is Treatment of Poland Syndrome a Definitive Solution?

Poland syndrome is a congenital developmental difference. Reconstruction can rebuild missing muscle volume, breast tissue, soft tissue, or certain parts of the chest wall. However, surgery does not guarantee:
  • Full restoration of the natural function of the missing muscle
  • Perfect symmetry
  • Completion of treatment in a single operation
  • That the implant will never need to be replaced
  • That all of the transferred fat will be permanent
  • That no scars will remain
  • That no complications will develop
  • Resolution of all body image concerns

Follow-Up After Treatment

Follow-up varies depending on the reconstruction performed. At follow-up visits, the following may be evaluated:
  • Chest and breast symmetry
  • Implant position
  • Fluid around the implant
  • Capsular contracture
  • Retention of grafted fat
  • Condition of transferred tissue
  • Wounds and scars
  • Shoulder movement
  • Muscle strength
  • Hand function
  • Growth
  • Psychosocial well-being
  • Need for additional corrections
CT or MRI is not required at every visit. Imaging is planned according to clinical need.

When Is Medical Evaluation Needed?

An evaluation for Poland syndrome may be considered in the following situations:
  • Marked lack of muscle volume on one side of the chest
  • Marked asymmetry between the right and left chest
  • One breast being underdeveloped
  • Differences in the nipple or areola
  • Absence of the anterior axillary fold
  • A marked depression of the ribs or chest wall
  • Short or webbed fingers
  • A marked difference in shoulder or arm strength
  • Chest or shoulder complaints during exercise
  • Body image significantly affecting daily life
Evaluation may also be needed after surgery or implant placement in the case of:
  • Sudden or increasing pain
  • Shortness of breath
  • Fever
  • Redness or discharge at the incision site
  • New swelling
  • Fluid around the implant
  • A sudden change in chest contour
  • Suspected implant displacement
  • A marked decrease in arm or shoulder strength
  • Uncontrolled pain

Frequently Asked Questions About Poland Syndrome

Is Poland syndrome a muscle disease?
Poland syndrome is not a progressive muscle disease. It is a congenital developmental condition, and its main feature is the underdevelopment of part of the pectoralis major muscle on one side of the chest.
Does every patient with Poland syndrome have a hand anomaly?
No. Hand and finger differences may occur with Poland syndrome but are not present in every patient. In some people, only the pectoralis major muscle is affected.
Does Poland syndrome progress with age?
The missing muscle tissue does not gradually disappear over time. However, the difference between the right and left sides may become more noticeable after growth, puberty, breast development, or muscle building.
Does exercising develop the missing chest muscle?
Existing muscle tissue can be strengthened with exercise, but the congenitally underdeveloped portion of the pectoralis major cannot be rebuilt through exercise.
Does Poland syndrome affect muscle strength?
Many people have normal or near-normal function in daily life. With a more extensive muscle deficiency or involvement of other shoulder muscles, strength differences may be seen in certain movements.
Can Poland syndrome be treated without surgery?
Not every case of Poland syndrome requires treatment. Physical therapy can support posture and shoulder function but does not rebuild missing muscle or breast tissue. The need for reconstruction is evaluated based on anatomical and functional characteristics.
What is a custom 3D implant?
It is an implant designed on a computer according to the patient's three-dimensional chest anatomy, intended to better fill the missing volume. Its main purpose is to correct the chest contour; it does not restore the function of the missing muscle.
Is a custom implant better than a standard implant?
Not always. A custom implant may offer an advantage in irregular anatomical deficiencies. In other patients, a standard implant, fat grafting, tissue transfer, or a combination of these may be more appropriate.
Can breast asymmetry be corrected in Poland syndrome?
Yes. Depending on the anatomical features, fat grafting, a breast implant, a tissue expander, muscle or free tissue transfer, nipple-areola reconstruction, or combined methods may be considered.
Will both sides be exactly the same after treatment?
Complete and permanent symmetry cannot be guaranteed. Because the underlying anatomical structures on the right and left sides are different, differences may reappear over time as a result of growth, weight changes, pregnancy, aging, and muscle development.

Conclusion

Poland syndrome is a congenital developmental condition usually characterized by underdevelopment or absence of the sternocostal portion of the pectoralis major muscle on one side of the chest. The findings may be limited to a mild asymmetry of the chest muscle. In some people, the following on the same side may also be affected to varying degrees:
  • Other chest or shoulder muscles
  • Ribs and costal cartilages
  • Breast tissue
  • Nipple and areola
  • Arm and forearm
  • Hand and fingers
The diagnosis is usually made by physical examination. Ultrasound can help evaluate the superficial chest muscles. Computed tomography may be used particularly for rib or structural chest wall anomalies. MRI can provide additional information about muscle and other soft tissues. Not every patient with Poland syndrome needs surgery. Treatment is determined by physical function, chest wall stability, age, remaining growth, psychosocial impact, and the anatomical structures that require reconstruction. Reconstruction options may include:
  • Fat grafting
  • Breast or pectoral implants
  • Custom-designed implants
  • Tissue expanders
  • Latissimus dorsi muscle transfer
  • Free tissue transfer
  • Nipple and areola reconstruction
  • Structural chest wall reconstruction in selected advanced cases
Custom chest implants can mimic part of the outer contour created by the missing pectoralis muscle but do not restore living muscle function. Structural chest wall implants, on the other hand, serve a different purpose and may be considered in selected patients with severe rib deficiency or chest wall instability. There is no single standard reconstruction method that can be applied to all patients with Poland syndrome. Muscle, bone, breast, soft tissue, shoulder, and hand findings should each be evaluated separately, and treatment should be planned according to the person's anatomical and functional characteristics.

Disclaimer: The information on this page is provided for general informational purposes only. It does not replace a medical examination, diagnosis, or an individualized treatment plan. The evaluation of Poland syndrome and the reconstruction options may vary depending on the anatomical structures affected, age, growth status, physical function, previous treatments, and the person's other health characteristics.

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