Lipomodeling of Poland's syndrome: a new treatment of the thoracic deformity.

Background: The severe forms of Poland's syndrome, with thoracic deformity, were until now very difficult to treat, with treatment involving complex surgery and implant insertion. Results were, in general, inadequate and the appearance unnatural. Our experience with fat transfer for breast reconstruction led us to propose reconstruction of the breast and thorax by serial fat transfer.

Methods: Our patient had a very severe form of Poland's syndrome with agenesis of the pectoralis major and latissimus dorsi muscles and lack of fusion of the fourth costal arch. She was treated by fat transfer, or lipomodeling. Lipomodeling was developed in our team in 1998 to augment breast volume after autologous latissimus dorsi flap reconstruction. Because this technique and use of an implant were not possible, we attempted reconstruction by repeated lipomodeling. The patient underwent five sessions at intervals of a few months, the first in August 2001.

Results: With 6 years of follow-up, the aesthetic, functional, and psychological results exceeded our expectations. In five sessions we were able to reconstruct a breast of natural shape, sensitivity, and consistency, and which was totally accepted by the patient. Mammography, echography, and MRI 1 year later showed a normal breast of fatty type.

Conclusion: Lipomodeling in Poland's syndrome is technically feasible. This original description of treatment of the severest form of Poland's syndrome, with impressive results and at the cost of limited constraints and scar sequelae, opens new perspectives and suggests extensive potential applications of lipomodeling in all disciplines related to the breast.