Oncoplastic technique for the elimination of the lateral "dog ear" during mastectomy

Following a mastectomy, both the cosmetic and functional results can be impaired by the presence of a lateral "dog ear." This is a particular problem in women with a large body habitus giving an increased amount of adipose tissue lateral to the breast. The standard approaches to this operation of horizontal or oblique incisions often results in an uncomfortable, unsightly lateral "dog ear". We describe a modification to the standard mastectomy incision that allows extensive excision of the lateral adipose tissue, re-draping the skin over the chest wall, thus eliminating the "dog ear." The mastectomy is performed through two oblique incisions originating in the axillary skin crease encompassing the nipple areolar complex, followed by extensive lateral fat excision. A distance of 2-3 cm is kept between the superior limit of the two incisions. At closure the lateral skin flap is advanced superiomedially on the chest wall without tension. This simple and reproducible technique improves cosmesis and patient satisfaction following modified radical mastectomy by eliminating the lateral "dog ear."