Bilateral Free Deep Inferior Epigastric Artery Perforator Flaps for Reconstruction following Mastectomy in Poland Syndrome Patients

• Published in: Plastic and reconstructive surgery. Global open 2023-11, Vol.11 (11), p.e5374-e5374
• Main Authors: Malekpour, Mahdi, Tozzi, Federico, Walker, John, Fries, Charles Anton, Hosein, Rayaad C.
• Format: Article
• Language: English
• Subjects: Breast; Special Topic
• ISSN: 2169-7574; 2169-7574
• DOI: 10.1097/GOX.0000000000005374

BackgroundPoland syndrome is classically described as symbrachydactyly, with hypoplasia of the pectoralis major and other upper thoracic musculoskeletal structures. It is thought to be caused by intrauterine interruption in subclavian arterial flow and often includes breast hypoplasia. Affected vasculature can pose a challenge for reconstruction with free flaps because inflow may not be reliable in this patient population.MethodsWe present the rare case of a 28-year-old woman with left-sided Poland syndrome, significant family history of breast cancer, and BRCA1+ mutation who underwent bilateral prophylactic nipple-sparing mastectomies with successful immediate bilateral deep inferior epigastric artery perforator free flap reconstruction. The surgical literature in this clinical scenario is also reviewed.ResultsPreoperative computed tomography angiography of the chest successfully demonstrated the patency and quantified the caliber of the internal mammary vessels to support free flap breast reconstruction.ConclusionsFree tissue transfer is a viable option for breast reconstruction in patients with Poland syndrome undergoing mastectomy guided by preoperative computed tomography angiography to characterize the internal mammary vasculature.