“Dog ears” is a term in plastic surgery for the small, noticeable bulges of excess skin and fat that gather at the ends of a surgical incision. This contour irregularity is a common result following various body contouring procedures, including breast reduction surgery. Although medically harmless, these protrusions can affect the smooth profile of the chest and may cause dissatisfaction with the final aesthetic outcome. The development of dog ears is a known, correctable issue in the healing process and should not be a source of undue alarm.
What Causes Dog Ears After Surgery
Dog ears are fundamentally a consequence of geometric considerations during wound closure. They arise when the skin edges being brought together are of unequal length, forcing the longer side to bunch up at the point where the incision ends. This bunching creates a small, cone-shaped mound of tissue, which resembles a pucker or fold.
The likelihood of this occurring increases in procedures like breast reduction, where a significant volume of tissue is removed. This creates a discrepancy between the large internal defect and the remaining skin envelope. Skin laxity, especially with age or previous weight fluctuations, means the skin may not retract smoothly. The tissue gathering often occurs at the points of greatest tension, particularly at the lateral ends of the horizontal incision.
The protrusion may not be solely excess skin but can also be residual subcutaneous fat that was not fully contoured during the initial procedure. This excess fatty tissue, or a combination of fat and skin, contributes to the visible bulge. Initial post-operative swelling can temporarily exaggerate the size of these bulges, so their early appearance should not be mistaken for their final form.
Initial Management and Waiting Period
Patience is a component of the initial management plan for dog ears, as many minor protrusions resolve naturally as swelling subsides and tissues settle. What may appear to be a permanent dog ear in the early weeks is often a “false dog ear,” which can diminish over the first three to six months following surgery. Most plastic surgeons will recommend a waiting period of six to twelve months before considering a revision, ensuring the tissue is fully healed and stable.
During this waiting period, non-surgical, patient-led actions can encourage tissue remodeling and contouring. Scar massage is an effective non-invasive technique that should be started once the incisions are completely closed and healed, typically a few weeks post-surgery. This technique involves applying firm, direct pressure with the fingertips to the dog ear and the surrounding scar tissue.
The goal of massage is to soften the scar tissue and encourage the underlying fluid and minor tissue bunching to flatten out. This should be performed for about five to ten minutes, two to three times a day, without causing undue pain. The consistent mechanical pressure helps break down any early, disorganized collagen fibers that contribute to the firmness of the bulge.
Compression garments, such as surgical bras, also play a supportive role in encouraging a smooth contour. The constant, even pressure applied by these garments helps to reduce fluid accumulation and molds the remaining soft tissues to the desired shape. Continued observation is necessary, as only those protrusions that persist beyond the six-to-twelve-month mark are considered true, permanent dog ears requiring further intervention.
Surgical Revision Procedures
If a dog ear remains a concern after the mandated waiting period, a minor surgical revision is the definitive solution to achieve a smooth chest contour. These procedures are typically straightforward and can often be performed in the surgeon’s office under local anesthesia, making them an outpatient affair with minimal downtime. The choice of technique depends on whether the protrusion is primarily excess skin, excess fat, or a combination of both.
When the dog ear is mainly composed of excess skin, the most common intervention is a direct excision. This involves removing a small, elliptical piece of skin and underlying tissue, effectively lengthening the incision slightly to allow the skin edges to be closed without tension. Techniques such as the straight line extension or M-plasty can be used to minimize the length of the new scar while effectively eliminating the pucker.
Alternatively, if the bulge is predominantly fatty tissue with little excess skin, focused liposuction may be the preferred method. This technique uses a small cannula inserted through a tiny incision to carefully suction out the localized fat deposits. Liposuction is an effective way to refine the area and restore a smooth transition without significantly extending the length of the external scar.