The breast-pectoralis flap: A major contribution to the treatment of severe thoraco-mammary deformities in Poland syndrome and associated syndromes - A case series of five patients

• The breast-pectoralis flap (BPF) offers an innovative solution for severe thoraco-mammary deformities in Poland syndrome and associated syndromes. • A case series of five patients, aged 11-16, demonstrated excellent aesthetic and functional outcomes. • The BPF enables tissue transfer from the contralateral breast, compensating for the absence of the latissimus dorsi in complex cases. • Complementary lipomodeling sessions are essential for achieving optimal morphological results. • No complications such as flap necrosis were reported, and patient satisfaction was rated as "very good" across all cases. The lipomodeling technique has transformed the management of Poland syndrome-associated thoraco-mammary deformities. Complex type 3 cases with significant thoracic deformity often require a combined approach, including the latissimus dorsi flap, which is absent in about 10% of cases. These patients face therapeutic challenges. The breast-pectoralis flap (BPF), developed for breast reconstruction, allows transfer of tissue from the contralateral breast. This study aimed to evaluate the BPF's contribution to correcting severe thoraco-mammary deformities in Poland syndrome and associated syndromes. We conducted a case series on five female patients aged 11–16 years between 2012 and 2024 to evaluate outcomes and complications of breast reconstruction using the BPF. Four had severe stage III Poland syndrome with marked thoracic deformity. One had sequelae from cystic lymphangioma treatment, lacking the latissimus dorsi and pectoralis major muscles, corresponding to severe stage III Poland syndrome. Evaluation criteria included aesthetic results, patient satisfaction, functional impact, and the number of lipomodeling sessions needed. The BPF enabled thoraco-mammary restoration in all patients. Additional lipomodeling sessions achieved the desired morphological results. All outcomes were “very good,” with no flap necrosis or other complications. Patient satisfaction was rated “very good” in all cases. The BPF is a valuable technique for treating severe thoraco-mammary deformities in Poland syndrome and should be part of the therapeutic arsenal for complex cases. However, it requires a delicate procedure by experienced plastic surgeons.