Boosting Fat Retention in Poland Syndrome

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Poland syndrome is a rare congenital condition characterized by unilateral musculoskeletal anomalies affecting the chest wall and upper limb.¹ The absence of the pectoralis major muscle is the primary manifestation, often accompanied by breast hypoplasia and, in some cases, additional skeletal or organ anomalies.² Autologous fat grafting has emerged as the preferred treatment to correct breast asymmetry, although issues with fat retention remain a challenge.¹ Recent research suggests that botulinum toxin may improve fat graft survival by enhancing vascularization and adipose-derived stem cell proliferation.³ A clinical study was conducted to evaluate the effectiveness of this approach, showing promising results for improving fat retention rates and patient satisfaction.⁴

Clinical Manifestations

Most patients present with unilateral breast hypoplasia, often leading to significant aesthetic concerns. Other manifestations may include:

• Rib anomalies
• Nipple-areola complex abnormalities
• Axillary hair absence
• Forearm shortening or muscular underdevelopment
• Syndactyly or brachydactyly

In rare cases, Poland syndrome is associated with non-musculoskeletal anomalies, such as pulmonary or renal malformations and dextrocardia.⁵

Treatment Approaches

The primary goal of treatment is to restore breast symmetry while minimizing surgical trauma. The study noted several reconstructive techniques that have been utilized:

• Prosthetic implants: Suitable for patients with adequate soft tissue coverage but associated with higher complication rates.
• Flap-based reconstruction: Involves tissue transfer from the latissimus dorsi or rectus abdominis, but donor site morbidity remains a concern.
• Autologous fat grafting: Considered the most favorable option due to minimal invasiveness and absence of foreign body reactions. However, variability in fat retention is a significant limitation.

Patients often seek the simplest surgical intervention possible to minimize additional trauma while achieving a normal appearance and aesthetic outcome. Given these considerations, researchers aimed to investigate the role of botulinum toxin in enhancing fat graft survival.

Botulinum Toxin and Fat Retention

A prospective study was conducted on 20 female patients diagnosed with Poland syndrome. Participants were randomly assigned to 2 groups:

• Control group: Received standard autologous fat grafting.
• Experimental group: Received fat grafting mixed with botulinum toxin.

Surgical Technique

Fat was harvested from the inner thigh, processed using the Coleman technique, and injected into the breast region. In the experimental group, researchers stated fat was mixed with botulinum toxin (100 U per 100 mL of fat). Patients underwent multiple sessions to achieve optimal retention rates.

Results

At 3 and 6 months postoperatively, the study found the experimental group demonstrated significantly higher fat retention rates (55.12% at 3 months and 43.67% at 6 months) compared to the control group (47.54% at 3 months and 35.64% at 6 months). Satisfaction scores, measured using the Breast-Q scale, were notably higher among patients receiving botulinum toxin treatment. Researchers stated the most common complication was the formation of calcified nodules, occurring in both groups at similar rates.

Discussion

The study found that botulinum toxin appears to improve fat graft retention by increasing neovascular density and stimulating adipose-derived stem cell proliferation. Researchers noted previous studies have indicated that botulinum toxin enhances vascularization via the hypoxia-inducible factor-1α/vascular endothelial growth factor pathway, which may explain its beneficial effects on fat survival. They suggested further research is needed to confirm these findings and optimize treatment protocols.

Conclusion

Poland syndrome significantly impacts patients' physical and psychological well-being, primarily due to breast asymmetry. Autologous fat grafting remains the preferred treatment modality, with botulinum toxin showing promise in improving fat retention rates. Researchers stated that future studies with larger sample sizes and longer follow-up periods are necessary to establish standardized treatment guidelines. Overall, the study found integrating botulinum toxin into fat grafting procedures may enhance clinical outcomes and patient satisfaction in Poland syndrome reconstruction.

References

1. Baldelli I, Baccarani A, Barone C, et al. Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence). Orphanet J Rare Dis. 2020;15(1):201. Published 2020 Aug 5. doi:10.1186/s13023-020-01481-x
2. Gocmen H, Akkas Y, Doganay S. Poland syndrome: rare presentation in two cases. N Z Med J. 2010;123(1321):71-77. Published 2010 Aug 27.
3. Shi N, Su Y, Guo S, et al. Improving the retention rate of fat grafts in recipient areas via botulinum toxin A treatment. Aesthet Surg J. 2019;39(12):1436-1444. doi:10.1093/asj/sjz073
4. Wang N, Wei S, Qiang S, et al. Autologous fat graft combined with botulinum toxin injection for breast augmentation in Poland syndrome: A prospective and comparative study. J Cosmet Dermatol. 2025;24(2):e70070. doi:10.1111/jocd.70070
5. Kim YH, Kwon WJ, Park SI. Anesthetic experience during reconstruction surgery of a chest wall defect in a patient with Poland syndrome: A case report. Korean J Anesthesiol. 2009;57(5):652-655. doi:10.4097/kjae.2009.57.5.652