Classification system and surgical design of developmental breast asymmetry / 中华医学美学美容杂志

Objective:To explore the classification and treatment strategies of developmental breast asymmetry (DBA).Methods:A retrospective study was conducted in adult female patients with developmental breast asymmetry deformity who underwent surgery between January 2005 to June 2019 in the Plastic Surgery Department of Peking Union Medical College Hospital. According to different clinical manifestations, DBA was divided into three types which adopted to different surgical strategies. Postoperative complications and patient satisfaction were evaluated.Results:A total of 203 patients were included in the study; 42.36% (86 cases) were type Ⅰ, 31.03% (63 cases) were type Ⅱ and 26.60% (54 cases) were type Ⅲ. The number of follow-up patients accounted for 79.3% (161/203). The mean follow-up time was 9 months. There were one case of poor healing of the axillary incision in latissimus dorsi muscle flap, two cases of seroma, five cases of Baker grade Ⅰ capsule contracture, two cases of Baker grade Ⅱ capsule contracture and one cases of small nodules in autologous fat breast augmentation. With regard to patient satisfaction, 80.1% (129 cases) felt satisfied with the aesthetic results, 15% (24 cases) felt good, 3.7%. (6 cases) felt average and 1.2% (2 cases) felt unsatisfied.Conclusions:This study shows that the clinical manifestations of DBA are varied, and our classification method is an effective and useful tool to guide the surgical treatment. Individualized surgical design is essential for aesthetical results.

Anomalía de Poland, a propósito de dos casos / Poland anomaly, about two cases

Introducción: el síndrome de Poland, conocido también como secuencia de Poland o anomalía de Poland, fue descrito por primera vez por Alfred Poland en 1841. Corresponde a una alteración musculoesquelética congénita, caracterizada por la ausencia total o parcial del músculo pectoral mayor, asociada a anormalidades de la extremidad superior ipsilateral. Objetivo: se presentan 2 casos de niñas que consultaron por asimetría mamaria, en el primer caso una niña de 12 años con ausencia del pectoral mayor y antecedente de postquirúrgicos sindactilia de mano derecha ipsilateral. El segundo caso, una niña de 9 años con asimetría mamaria sin alteración en la extremidad. Conclusión: la anomalía de Poland o secuencia de Poland es una alteración musculoesquelética de presentación infrecuente, de aparición esporádica, de mayor prevalencia en masculinos, afecta generalmente el lado derecho del cuerpo, muy pocas veces amerita tratamiento quirúrgico

Introduction: Poland syndrome, also known as Poland sequence or Poland anomaly, was first described by Alfred Poland in 1841. It corresponds to a congenital musculoskeletal disorder, characterized by the total or partial absence of the major pectoral muscle associated with limb abnormalities ipsilateral superior. Objective: There are 2 cases of girls who consulted for breast asymmetry, in the first case a 12-year-old girl with absence of the pectoralis major and a history of post-surgical syndactyly of the right ipsilateral hand, the second case a 9-year-old girl with breast asymmetry without limb alteration Conclusion: The anomaly of Poland or sequence of Poland is a musculoskeletal alteration with an infrequent presentation, of sporadic appearance, more frequent in males, 10 frequently affecting the right side of the body, very rarely merits surgical treatment.

Assimetrias mamárias na infância e adolescência / Breast asymmetries in children and adolescents

Para facilitar o diagnóstico clínico e diferencial é de grande importância para os profissionais médicos, principalmente pediatras e ginecologistas, o entendimento e o manejo das alterações mamárias que podem apresentar-se em crianças e adolescentes. Destacamos, principalmente, o desenvolvimento das mamas, que causa preocupação das adolescentes com as alterações do seu crescimento. Investigamos as causas, características e o diagnóstico das mamas assimétricas em crianças e adolescentes.

Laparoscopic treatment of Poland's syndrome using the omentum flap technique

OBJECTIVE: For patients with Poland's syndrome, a transverse skin fold in the anterior axillary pillar, infra-clavicular depression and an anomalous breast contour are the most uncomfortable disfigurements. This study aims to demonstrate that superior aesthetic results can be achieved by using a laparoscopically harvested omentum flap to treat this condition. METHODS: From a prospectively maintained clinical database of patients undergoing a laparoscopic omentum flap procedure for breast reconstruction, all of the patients with Poland's syndrome were identified and their outcomes were studied. RESULTS: Thirteen consecutive patients with Poland's syndrome were treated and evaluated regarding breast contour, reconstruction of the anterior axillary pillar and filling of the infra-clavicular depression. Implants were employed beneath the flap in 76 percent of cases to improve symmetry. In 23 percent of cases, a contra-lateral mastopexy was performed, and in 15 percent of cases, a breast implant was used. The consistency of the flap is similar to natural breast tissue and only a small incision in the breast fold is needed. The majority of patients (85 percent) were female, with a mean age of 26 (18-53). The flap is extremely malleable, adapts to irregular surfaces, and has a long vascular pedicle. Additionally, its removal does not leave a scar at the donor site as the removal of muscular flaps does. For example, the removal of the latissimus dorsi flap causes a deformity in the dorsal contour. The mean operative time was 201 minutes (80-350) and the mean hospital stay was 2.3 days (1-5). CONCLUSIONS: The outcomes of these patients revealed that the omentum flap technique provided superior amelioration of the deformities caused by Poland's syndrome when compared with other reconstructive options.