Q: Dr. Eppley, I have a problem with the right side of my chest. It is smaller and looks completely different from my left side. I have noticed it since I was a small boy and it has always embarrassed me. It looks like I do not have a chest muscle on my right side. I want to know what can be done for it. I have attached some pictures including ones with my arm raised where you can really see the difference.
A: Thank you for sending your pictures. It does appear that you have Poland’s syndrome. This is an underdevelopment of the pectoralis chest muscle. It is a well known congenital chest deformity. This can clearly be seen in your pictures, particularly the one with the arms lifted. You can see the short pectoralis muscle and its abnormal attachment to the upper sternum. This accounts for your smaller right chest appearance, the high position of the right nipple, and the asymmetry between the two sides of your chest.
In treatment of male Poland’s syndrome, several treatment options are available which primarily focus on improving the volume of the right chest. This can be done with an implant, a pedicled latissimus dorsi muscle flap or a combination of both. A pectoralis implant is the simplest approach but the lower edge of implant will not have muscular coverage so the lower edge may be palpable or visible when the arms are lifted. Other treatment options include scar release/lengthening of a tight muscle band across the armpit and possible right nipple repositioning. It is also important to look at the opposite chest to see of anything can be done there to help improve the symmetry between both sides of the chest.