Mojallal Ali, Shipkov Christo, Braye Fabienne
Department of Burns and Plastic, Reconstructive and Esthetic Surgery, Hospital Eduard Herriot, Lyon, France.
Folia Med (Plovdiv). 2008;50(1):63-9.
The breast deformity in females with Poland anomaly (Poland syndrome) can be particularly embarrassing from esthetic and social point of view. Various methods of breast reconstruction were reported comprising breast implants, latissimus dorsi (LD) flap or the combination of these two. The aim of this study was to present a breast reconstruction in Poland anomaly with endoscopically-assisted LD muscle flap in association with autologous fat tissue transfer and to analyse the results in the light of the literature data.
An 18-year-old woman presented with severe left breast hypoplasia (in the context of a Poland anomaly) with heavy social and psychological impact on both private and professional life. No thoracic deformity was clinically and radiologically detectable. The preoperative imaging studies of the breast (mammography and ultrasound) did not show any pathological findings. A three-stage autologous breast reconstruction was performed. An endoscopically assisted LD muscle flap was carried out during the first stage. This was followed by two stages of autologous fat tissue transfer and reduction mammaplasty of the opposite breast.
No postoperative complications were observed. The postoperative pain was less intensive than in the classic open technique. The LD muscle harvesting was carried out through a smaller incision which left a smaller back scar. The final result was breast symmetry of excellent quality.
The breast reconstruction in Poland anomaly can be performed with entirely autologous techniques. Endoscopic techniques in LD harvesting leave smaller scars and cause less postoperative pain. The autologous fat tissue transfer can be an useful adjunct to the classic flap techniques provided that safety requirements in technique and follow up are strictly observed.
从美学和社会角度来看，患有波兰综合征的女性乳房畸形可能会特别令人尴尬。据报道，乳房重建的方法多种多样，包括乳房植入物、背阔肌（LD）皮瓣或两者结合。本研究的目的是介绍一种采用内镜辅助LD肌皮瓣联合自体脂肪组织移植进行波兰综合征乳房重建的方法，并根据文献数据分析结果。
一名18岁女性因严重左侧乳房发育不全（波兰综合征）就诊，这对其私人生活和职业生活均造成了严重的社会和心理影响。临床和影像学检查均未发现胸廓畸形。乳房的术前影像学检查（乳房X线摄影和超声检查）未发现任何病理结果。进行了三阶段自体乳房重建。第一阶段采用内镜辅助LD肌皮瓣。随后进行了两阶段自体脂肪组织移植和对侧乳房缩小整形术。
未观察到术后并发症。术后疼痛比传统开放技术轻。LD肌的获取通过较小的切口进行，背部留下的疤痕较小。最终结果是乳房对称性极佳。
波兰综合征乳房重建可采用完全自体技术进行。内镜技术在获取LD肌时留下的疤痕较小，术后疼痛较轻。只要严格遵守技术和随访中的安全要求，自体脂肪组织移植可以成为经典皮瓣技术的有用辅助手段。
