Poland Syndrome

Poland syndrome is a congenital condition in which part of the pectoralis major muscle is underdeveloped or absent, usually on one side. It may also involve the chest wall, breast, nipple and areola, upper limb, and hand.

Differences may involve the pectoral muscles, chest wall and ribs, breast and nipple-areola complex, shoulder, arm, forearm, and hand. The combination and severity of these features vary widely between individuals.

No. Some people have only mild asymmetry of the chest, breast, or nipple, while others have absent breast tissue, a more pronounced chest wall deformity, or upper-limb and hand differences.

In men, absent or underdeveloped muscle may be most noticeable in the contour of the chest. In women, the condition may affect breast development, shape, volume, and position. Upper-limb or hand differences may occur in either sex.

No. Some people have no hand abnormality, while others have varying degrees of hand hypoplasia, webbed fingers, or symbrachydactyly. Assessment should include the entire upper limb because the wrist, elbow, shoulder, or shoulder blade may also be involved.

Diagnosis is mainly clinical and is based on the characteristic pectoralis major difference together with any associated findings. Ultrasound is generally the first-line imaging test. X-rays, CT, or MRI are used selectively, particularly when significant bony abnormalities are suspected or surgery is being planned.

No. It is a congenital, non-progressive condition. Follow-up may still be useful during growth to assess development of the chest, breast, and upper limb and to decide whether treatment is appropriate.

Most cases are sporadic and occur without other affected relatives. Rare familial cases have been reported. Genetic counselling may be helpful when there is a family history, concern about recurrence, or other congenital differences.

No. The decision depends on the features present, hand and upper-limb function, the severity of any chest wall difference, its effect on wellbeing, and the person's own priorities. An underdeveloped but functional hand, for example, may not require surgery.

There is no single age that is right for every patient. Planning usually considers chest and breast growth, physical and psychological maturity, and the type of reconstruction required. Severe chest wall differences or other specific circumstances may require a different timetable determined by an experienced multidisciplinary team.

Depending on the anatomy, reconstruction may use transfer of the latissimus dorsi muscle to the pectoral area or a silicone prosthesis to reproduce muscle volume. Fat grafting may be used alone in mild cases or as an adjunct to other techniques.

The aim is to create or improve breast symmetry. Options may include implants, sometimes after tissue expansion, fat grafting, and reconstruction using the patient's own tissues. Areola or nipple reconstruction may be performed at a later stage when needed.

Surgery is considered when the abnormality limits function or when the anatomy may benefit from finger separation or another reconstructive procedure. The indication and timing depend on the type of difference and should be planned by a paediatric or reconstructive hand surgery team.

Yes. Reconstruction may be staged, and later adjustments may sometimes be needed. Growth, weight changes, pregnancy, changes in the tissues, and the presence of implants can alter symmetry and lead to additional procedures.

These depend on the extent of the differences and the chosen procedure, such as fat grafting, an implant or expander, muscle transfer, tissue-flap reconstruction, or hand surgery. Possible problems include wound-healing difficulties, infection, seroma, implant-related complications, or further surgery. Scar location, hospital stay, and recovery should therefore be explained for the individual treatment plan.