Achilles tendon allograft implantation for anterior axillary fold reconstruction in Poland syndrome.

Background: Poland Syndrome (PS) is a rare congenital condition characterized by unilateral pectoralis major hypoplasia or aplasia, often with associated anterior axillary fold deficiency. Conventional reconstructive options carry inherent limitations including donor-site morbidity and unpredictable volume retention. This report describes the first use of an Achilles tendon allograft to reconstruct the anterior axillary fold in a PS patient with prior silicone implant placement. Case: A 48-year-old male presented with persistent anterior axillary fold deficiency following prior left pectoralis major reconstruction with a silicone implant. Reconstruction was performed using an Achilles tendon allograft secured to the proximal humerus via suture anchors and to the implant capsule through a tendon-osseous repair technique adapted from pectoralis major rupture surgery. Findings: At four-year follow-up, the patient maintained full shoulder range of motion, durable anterior axillary fold contour, and satisfactory cosmetic outcome, with no graft failure, implant displacement, or animation deformity. Conclusion: Achilles tendon allograft implantation offers a novel, less invasive reconstructive option for anterior axillary fold restoration in PS, avoiding donor-site morbidity while providing durable structural support.