"Nipple-centered customized skin expansion for breast reconstruction in female patients with Poland syndrome: A reproducible protocol".

BACKGROUND: Poland syndrome in female patients is frequently associated with complex breast and chest wall asymmetry and requires individualized reconstructive strategies to achieve satisfactory symmetry while minimizing morbidity. METHODS: A retrospective observational study was conducted on female patients with Poland syndrome who underwent two-stage alloplastic breast reconstruction between 2012 and 2023. Customized positioning of anatomical tissue expanders was used to reshape the skin envelope of the affected hemithorax and correct vertical and horizontal nipple-areola complex malposition. Anthropometric measurements, including sternal notch-to-nipple and midsternal line-to-nipple distances, were collected preoperatively and postoperatively. Statistical analyzes were used to evaluate symmetrical outcomes and correlations with some variables, including body mass index (BMI). RESULTS: Twenty-four patients were included. Mean sternal notch-to-nipple distance on the affected side improved from 16.04 ± 1.47 preoperatively to 19.10 ± 1.32 cm postoperatively, whereas midsternal line-to-nipple distance improved from 8.77 ± 1.20 to 11.06 ± 0.98 cm. Higher BMI was associated with greater residual postoperative sternal notch-to-nipple asymmetry in an exploratory analysis. CONCLUSIONS: The proposed two-stage alloplastic algorithm achieved measurable anthropometric improvement in nipple-areola complex positioning in female patients with Poland syndrome. By combining customized expander orientation with staged implant reconstruction, this approach provides a reproducible strategy for reshaping the skin envelope and facilitating final breast symmetry while limiting donor-site morbidity. LEVEL OF EVIDENCE: Therapeutic, IV.