A 19-year-old male patient was admitted to our facility due to chest wall and breast asymmetry. Clinical and radiological examinations revealed the absence of the sternocostal head of the right pectoralis major muscle and right serratus anterior muscle, hypoplasia of the right pectoralis minor muscle, an elevated right small scapula, and contralateral gynecomastia (Figures 1a and 2a-c). The right nippleareola complex (NAC) was also smaller and had a superior localization (Figure 1a). The patient was diagnosed with Poland’s syndrome accompanied by Sprengel’s deformity and contralateral gynecomastia. A medial dermal NAC pedicle was then used for the gynecomastia repair. The aesthetic result was reasonable, and the patient was fairly satisfied with the results (Figure 1b).

Figure 1: (a) Photograph of the anterior chest wall showing the absence of the sternocostal head of the right pectoralis major muscle along with the left-sided gynecomastia. (b) Photograph of the anterior chest wall after correcting the gynecomastia.

Figure 2: (a) Axial noncontrast-enhanced computed tomography showing the absence of the sternocostal head of the right pectoralis major muscle and the hypoplasia of the right pectoralis minor muscle. (b) Axial noncontrast-enhanced computed tomography showing the absence of the right serratus anterior muscle and the hypoplasia of the right scapula. (c) Three-dimensional volume rendering showing the absence of the sternocostal head of the right pectoralis major muscle along with the absence of the right serratus anterior muscle.

Poland’s syndrome is a rare congenital anomaly characterized by the partial or complete absence of the pectoral muscle. It may be accompanied by breast and nipple abnormalities, a paucity of subcutaneous tissue, rib deformity, axillary and pectoral alopecia, and unilateral hand anomalies,[1] but many additional anomalies, such as Sprengel’s deformity (a congenital elevated and small scapula), may also be present.[1] Gynecomastia is the benign enlargement of the male breast, and to the best of our knowledge, only one patient with both Poland’s syndrome and gynecomastia has been reported in the literature.[2] However, to the best of our knowledge, our patient was the first to be diagnosed with the combination of Poland’s syndrome, Sprengel’s deformity, and gynecomastia. For patients with Poland’s syndrome and contralateral gynecomastia, the first treatment modality should be to correct the latter condition.

Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding
The authors received no financial support for the research and/or authorship of this article.

References

1) Fokin AA, Robicsek F. Poland’s syndrome revisited. Ann Thorac Surg 2002;74:2218-25.

2) Mahoney J, Hynes B. Concurrent Poland’s syndrome and gynecomastia: a case report. Can J Surg 1990;33:58-60.