Surgical techniques to avoid lateral dog ear of the mastectomy scar: A systematic review

• A dog ear formation at the lateral aspect of the mastectomy scar is a common clinical problem.
• It is cosmetically unpleasing and also a source of discomfort to the patients.
• We conducted the 1st systematic review of the surgical techniques reported for tackling dog ear formation.
• Fish-shaped’ incision or Y closure is the commonest described technique that has been prospectively assessed to be safe.

IntroductionMastectomy is commonly performed for breast cancer. However, a dog ear may arise at the lateral aspect of the mastectomy scar. This dog ear is not only unsightly but can also be a source of discomfort. While various surgical techniques have been reported to tackle this lateral dog ear, there is no standardized technique. We hence conduct the first systematic review of these surgical techniques with the aim of comparing the merits and limitations of each technique.MethodsA systematic literature search using the search terms “mastectomy scar”, “mastectomy dog ear”, “mastectomy lateral fold” and “mastectomy cosmesis” was performed. All relevant articles written in English and involving human subjects were included.ResultsThere were 2503 potentially relevant articles but only 12 articles met the inclusion criteria. The ‘fish-shaped’ incision or Y closure and its variations were the most commonly described techniques. Other techniques include the ‘tear-drop’ incision, ‘L’ scar technique etc. ‘Fish-shaped’ incision or Y closure is safe and provides good exposure to the axilla but its limitations are that of an additional scar and risk of skin necrosis at the apex of the Y incision. The other techniques attempt to eliminate the lateral dog ear while avoiding the complications associated with the ‘fish-shaped’ incision or Y closure.ConclusionVarious surgical techniques to tackle lateral dog ear of the mastectomy scar have been described, each with its own merits and limitations. ‘Fish-shaped’ incision or Y closure is the most commonly described technique that has been prospectively assessed and was concluded to be safe.