Dog ears are a common outcome following breast surgery, particularly procedures like mastectomy or large lumpectomies where significant tissue is removed. The term describes a small protrusion of excess skin and subcutaneous fat that gathers at the ends of an incision line. This formation is a well-recognized occurrence in surgeries that involve closing a long incision across a curved surface of the body, such as the chest wall. Dog ears are typically a benign cosmetic result of the body’s anatomy interacting with the mechanics of surgical closure.
Appearance and Formation
Dog ears appear as a small, triangular mound or pucker of tissue, generally located at the lateral edges of the mastectomy scar, often near the armpit. This bunching effect is a folding of the skin and underlying soft tissue that fails to lay flat against the chest contour. The appearance can range from a subtle fullness to a noticeable fold that may cause chafing.
The formation mechanism is rooted in the geometry of surgical excision and closure. The surgeon removes breast tissue, requiring a long, elliptical incision. When closing this incision in a straight line, the skin’s length often exceeds the length of the underlying tissue removed, especially on a curved body part. This discrepancy forces the excess tissue at the incision’s ends to gather, resulting in the characteristic pucker.
Factors like body mass index (BMI), the amount of tissue removed, and the presence of fat in the armpit region increase the likelihood of dog ear development. Patients with a larger body size or greater breast volume are at a higher risk of having residual excess tissue along the lateral chest wall. Surgeons sometimes employ techniques like extending the incision or using specialized closures to minimize this effect.
Addressing Medical Concerns
A frequent concern among patients is whether this excess tissue represents a complication or a recurrence of the original medical condition. Dog ears are overwhelmingly a cosmetic or contour issue and do not typically pose a health risk. The tissue involved is generally benign skin and fat that was not fully incorporated into the initial closure.
Surgeons generally recommend a period of observation before considering any corrective procedure. The tissue often appears more pronounced immediately after surgery due to post-operative swelling and fluid retention. This temporary swelling can mimic a dog ear, sometimes called a “false dog ear,” which may resolve as the body heals.
The standard practice is to wait approximately six to twelve months following the initial mastectomy or reconstruction before addressing these contour irregularities. This waiting period allows for the maximal reduction of swelling, scar maturation, and the final settling of the surrounding tissues. Waiting ensures that any remaining tissue requiring correction is permanent, not simply a temporary result of the surgical trauma.
Correction Procedures
When a dog ear persists beyond the recommended waiting period and causes discomfort or cosmetic dissatisfaction, a patient may choose to undergo a minor correction procedure. This procedure is often referred to as a dog ear revision or an excisional procedure. It is one of the most common reasons patients seek revision surgery following a mastectomy.
The revision is typically a straightforward, outpatient surgery often performed using local anesthesia. The technique involves surgically removing the small, triangular wedge of excess skin and fat. To ensure a smooth closure and prevent the recurrence of the pucker, the surgeon usually extends the original mastectomy incision slightly.
The resulting scar is a slight extension of the original mastectomy scar, but the overall contour of the chest wall is smoothed. The recovery time is generally much faster and simpler than the initial mastectomy, often involving minimal downtime.
Alternative Techniques
In some cases, for dog ears that are primarily composed of fat rather than skin, targeted liposuction may be used as an alternative or supplementary method to refine the contour.