Gender-affirming top surgery, typically a mastectomy, aligns the physical body with gender identity by creating a flatter chest contour. While the surgery successfully removes breast tissue, patients may sometimes notice a small, localized irregularity near the ends of the incision lines. This common contour issue is informally known as a “dog ear,” a term used in plastic surgery to describe a minor accumulation of tissue. This article explains the characteristics of dog ears, the reasons they appear, and the options available for their correction.
What Dog Ears Look Like and Where They Form
A dog ear is a small, triangular protrusion of skin and subcutaneous tissue that forms at the very end of a surgical incision. The name comes from its visual resemblance to the folded corner of a book page or a slight pucker of material. Although they do not pose a medical risk, dog ears can be an aesthetic concern for patients seeking a completely flat chest contour. These formations are usually located at the periphery of the chest, most frequently near the armpit or the lateral chest wall where the incision terminates. The accumulation is composed of excess skin and underlying fat tissue that did not lay flat during wound closure.
Factors Contributing to Their Appearance
The primary cause of a dog ear is the physics of closing a long incision after removing a large volume of tissue. When the wound edges are brought together, the skin is stretched over a smaller circumference, resulting in a gathering effect at the ends. This excess skin and fat are pushed outward as the incision is closed under tension, creating the characteristic puckering. Individuals with higher body mass index or those who carry more subcutaneous fat in the lateral chest wall are more susceptible, as this residual fat adds volume that must be accommodated.
The elasticity of a patient’s skin also influences how well the tissue contracts and settles into the new contour. Skin with less natural elasticity may be less able to shrink down following tissue removal, making it more prone to bunching at the edges. Surgeons often employ specialized techniques to minimize this effect, such as extending the incision line further toward the back to distribute tension. Strategic use of liposuction in the lateral chest and armpit area can also help smooth the contour by removing excess fat.
Options for Revision and Correction
Because initial swelling can mimic a dog ear, surgeons recommend waiting at least six to twelve months after the initial surgery for the body to fully heal and the skin to contract. During this time, minor cases may resolve naturally. If a dog ear persists after the full recovery period, it can be corrected through a minor surgical revision.
This revision is highly localized and often performed in an outpatient setting using only local anesthesia. The procedure involves making a small incision to surgically remove the triangular wedge of excess skin and fat to achieve a smooth, flat contour. If the dog ear is composed mainly of fat with minimal excess skin, targeted liposuction alone may be sufficient to flatten the area.