This patient is a seventeen-year-old female with Poland syndrome, resulting in a hypotrophic left pectoralis major muscle and rib anomalies. A tissue expander is implanted on the left side to increase the capacity of the left breast tissue in order to make room for a future, permanent implant.
The preoperative plan for breast reconstruction in this patient with Poland Syndrome was twofold, to use a combination of autologous tissue and prosthetic material. However, exposure of the breast tissue revealed more tissue to work with than anticipated, so an intraoperative decision was made to forgo the latissimus dorsi flap and use a tissue expander replaced with a permanent implant in a subsequent operation. A regenerative tissue matrix was placed between the tissue graft and native tissue to prevent movement of the tissue expander and promote repair. The tissue expander will later be replaced by a permanent implant.
Placement of a breast tissue expander is indicated when the pectoralis major and overlying skin need to be stretched in order to make room for a future, permanent implant. This video describes the case in a patient with Poland Syndrome, however breast tissue expansion is also common after patients undergo mastectomies.
Tissue may fail to expand and poor wound healing may occur in patients also undergoing radiation. Smokers also have a higher risk of poor wound healing and a higher risk of infection.
- Planning and marking for incisions and flap - General anesthesia - Prep area with chlorhexidine gluconate
Complete history and physical are complete prior to procedure. Risks and possible complications are discussed with patients and parents.
Left pectoralis major and minor, subcutaneous tissue
There were no complications during this procedure.
The contributors to this video have no conflicts of interest to disclose.
Ortiz, Juan A. “Poland's Breast Reconstruction With Decellularized Human Dermal Allograft.” Military Medicine, vol. 179, no. 2, 2014, doi:10.7205/milmed-d-13-00276. Regan, John-Paul, and Adam D. D. Schaffner. “Breast, Reconstruction, Expander Implant.” StatPearls Publishing, Jan. 2018. Seyfer, Alan E., et al. “Poland Syndrome: Evaluation and Treatment of the Chest Wall in 63 Patients.” Plastic and Reconstructive Surgery, vol. 126, no. 3, 2010, pp. 902–911., doi:10.1097/prs.0b013e3181e60435.