jiafm, 2010-32(2) april-june. - forensic medicine

J Indian Acad Forensic Med, 32(2) ISSN 0971-0973‣ The other breast on the right side was presentand borne features of changes during pregnancy.‣ Both the upper limbs and lower limbs are normalDiscussion:Amastia:Definition: [1]Amastia is the total absence of breast tissue. Atheliais the absence of nipple. In Hypomastia there isunderdevelopment of breast tissue and the nipple isusually present.Developmental cause of Amastia:Lack of formation or obliteration of milkline.Amastia can also be due to: [1] [2] Teratogen exposure [1] [2] Injuries sustained during – [1]• Thoracotomy• Chest tube placement• Inappropriate biopsy ofthe breast bud• Radiotherapy• Severe burnsAmastia may be associated with CongenitalEctodermal Dysplasia and Poland‟s Syndrome.[1] [2]Poland‟s Syndrome: [1] [3]The initial description of Poland‟s Syndrome firstappeared in the English literature in 1841 written byAlfred Poland (1822-1872), who was a medicalstudent at the Guy‟s Hospital, London, althoughGerman and French cases had been described earlier.Definition: By definition, all children with Poland‟sSyndrome have aplasia or hypoplasia of thesternocostal portion of the Pectoralis major muscleand at least one other associated lesion. [1]Incidence: [1] [3]It has a sporadic occurrence estimated at1:30,000 to 32,000 live births. [1] [3]It is rarely familial [1] [3]More commonly involves right side. [3]One out of six patients with Amastia orHypomastia have Poland‟s syndrome [3]Developmental causes of Poland‟s syndromesuggested are: [1] [3]Abnormal migration of the embryonictissues forming the pectoral musclesHypoplasia of the subclavian arteryIn utero injuries from attempted abortionNone of these theories have been uniformlyaccepted.Clinical features: [1] [3] Poland‟s syndrome is a constellation ofanomalies. [3] Children demonstrate remarkable diversity.[1] The predominant defect varies, dependingon the extent of involvement of differentparts.[1] The degree of abnormality of the hand,breast or chest wall varies. [3] Pectoralis major may be partially absent ortotally missing. Generally, the sternocostalcomponent of the Pectoralis major is themissing portion. [1] [3] [4] Pectoralis minor, Serratus anterior,Lattisimus Dorsi, Rectus Abdominis may bedeficit or absent. [3] Abnormalities of breast may includeAmastia, Hypomastia or Athelia. [3] Nipple, if present, may be lightly pigmentedand higher on the chest than the normalcontralateral nipple.[1] Syndactyly and brachydactyly may be seenin the hands. [1] [3] Aplasia of two to three ribs (second to fifthribs mostly) may be present. [1] Chest wall deformity so severe that it mayrequire surgery. [1] Scanty subcutaneous fat. [1] [3] Absent axillary hair. [1] [3]Investigations: [1]CT scan has been helpful in assessing:a) The chest wall configurationb) Extent of involvementTreatment: [2] [3]Surgical repair is rarely required except in certaincases. [2]Because of rarity of this condition, optimal treatmenthas not been adequately investigated. Some of thereasonable options are:a) Use of Transversus- Rectus AbdominisMuscle (TRAM) flap for reconstruction ofbreasts. [2]b) Tissue expansion and implant placement. [2]c) Reconstruction of aplastic ribs withautologous rib grafts. [3]Conclusion:Congenital anomalies are important data inIdentification but these have got other dimensionstoo. In a country like India, birth of a female child ishighly unwelcome amongst many communities. In agirl child with anomaly (especially of the breast),underlying depression resulting from social stigmadue to such deformity and the grim prospect ofmarriage, may be the cause behind such victimsbecoming easy prey of criminals who take advantageof their vulnerable minds by giving them falseassurance of marriage.177