Abbreviations DIEP Deep inferior epigastric perforator flap LDF Latissimus dorsi muscle myocutaneous flap SGAP Superior gluteal artery perforator flap TRAM Transverse rectus abdominis myocuta- neous flap Poland’s Syndrome Poland’s syndrome was first described by Alfred Poland as a medical student in London in 1841. Although Lallemand and Froriep presented patients with similar anomalies, Alfred Poland’s description is by far the most precise and comprehensive. 7 The sine qua non of Poland’s syndrome is the absence of a sternocostal portion of the pectoralis major muscle, a hypoplastic or absent breast and/or nipple–areola complex, and may include upper-extremity abnormalities such as hypoplasia of the hand, forearm, and arm. This may also include complete or incomplete syndac- tyly and short fingers. The chest wall can have abnormalities with depressed ribs and occasional absence of the latissimus dorsi muscle, serratus anterior muscle, and external oblique muscle. Absence of the pectoralis major muscle occurs with an incidence of approximately 1:7,000 to 1:1,00,000 live births. It commonly affects males 29 Congenital Breast Malformations Armand Lucas and Serdar Nasir Summary Congenital breast deformities pose a chal- lenging dilemma in plastic surgery. The expression of the abnormality may be complete, and anatomic components are often missing, deformed, or weakened. Most breasts are naturally asymmetrical. These asymmetries may include discrepancies in breast size and shape, location of the nipple–areola complex, the inframammary fold, or skeletal abnor- malities (see Figure 29.1). Breast abnormali- ties can cause emotional and psychological trauma, resulting in social maladjustment and associated behavioral problems. The majority of patients are young healthy indi- viduals who seek aesthetic restoration of their deformities. Preoperative evaluation begins with a thorough medical and surgical history, par- ticularly related to breast disease. Physical examination includes identification of chest wall or musculoskeletal deformities; shape, symmetry, and volume of both breasts; the presence and degree of ptosis; the position of the inframammary folds; and anomalies of the nipple–areola complex. Most of these anomalies require a multistage surgical approach, and the patient must be exten- sively counseled. M.Z. Siemionow and M. Eisenmann-Klein (eds.), Plastic and Reconstructive Surgery, 413 Springer Specialist Surgery Series, © Springer-Verlag London Limited 2010