BACKGROUND
Mastectomy in large breasted patients frequently results in an excess of tissue laterally (the ‘dog-ear’ deformity). This may interfere with the fitting of a brassiere (and/or prosthesis).
TECHNIQUE
Our mastectomy technique involves a D-shaped incision, skewed laterally, together with the excision of an additional triangular area at the base of the lateral end (Figs 1 and 2). The defect is closed beginning laterally and the superior flap is intentionally disproportionately advanced across the lateral half of the inferior flap, such that lateral and superior skin is distracted medially (Fig 3). Multiple interrupted subcutaneous sutures are placed, followed by a continuous subcuticular suture closure of skin. The final result is a scar that gently slopes inferiorly at its lateral extent but with elimination of the dog-ear deformity (Fig 4).
Figure 1.
The incision is modified to excise an additional triangle of skin that lies inferior to the area of redundant tissue.
Figure 2.
Illustration of a D-shaped incision with modified Burow’s triangular excision for advancement (shaded). The D shape is skewed laterally.
Figure 3.
The defect is closed, from medial to lateral. A skin hook marks the lateral extent of the ‘D’ to allow accurate apposition of the skin at the apex. The anterolateral part of the superior skin flap is actively advanced into a more anterior position.
Figure 4.
Final result
DISCUSSION
Previous techniques to avoid the dog-ear deformity following a mastectomy have included the fish-tail plasty method, which results in a Y-shaped closure.1—3 However, the disadvantages of this method are that it involves additional scarring, potentially creates two smaller dog ears and can be complicated by skin necrosis at the Y confluence. Another alternative is a teardrop shape incision but this is less predictable in its outcome depending on the point at which the lateral apex of closure is commenced.4
Our technique results in consistently good cosmetic and functional outcomes. The triangular component of the technique may be regraded as a modified Burow’s triangle excision.5 Excess tissue is removed laterally while avoiding buckling of the tissues that would create a dog-ear effect.
References
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