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

Abstract

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% of cases to improve symmetry. In 23% of cases, a contra-lateral mastopexy was performed, and in 15% 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%) 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.

Keywords: Breast asymmetry; Breast deformities; Laparoscopically harvested omentum flap; Omentum flap; Poland’s syndrome.

Figure 1

A latissimus dorsi flap deformity of the right side. Although subtle, this difference can be very uncomfortable when wearing certain clothes.

Figure 2

Four ports are usually used to harvest the omentum flap.

Figure 3

From left to right, elevation of the gastric wall, ligations of the short gastric arteries, liberation of the colon segment, ligation of the left gastro-epiploic artery, incision in the peritoneum to pull the omentum flap (using a finger maneuver) from the abdominal cavity to the breast region.

Figure 4

The omentum flap on the thoracic wall.

Figure 5

Top: A Poland’s syndrome patient missing the right breast who was treated with a tissue expansor and prosthesis and has an unpleasant transverse sulcus in the axillary pillar, an infraclavicular depression and an anomalous breast contour. Bottom: The same patient after a laparoscopically harvested omentum flap transposition to the right side that covers the prosthesis and conceals the infraclavicular depression and the anomalous breast contour. A mastopexy was performed on the opposite side in order to achieve a symmetric result.

Figure 6

A patient with Poland’s syndrome on the right side. Nineteen days after the omentum flap transposition, it is possible to see the beginning of the omentum’s growth in the lateral portion of the breast. Two months after omentum flap transposition only, the right breast had doubled in size, becoming bigger than the left breast. In the last picture, the right side has received a 200 cc high-profile implant while the left side has received a 225 cc low-profile implant.