Avoiding "dog ears" after top surgery, particularly a double incision mastectomy, involves a combination of careful surgical planning, skilled execution, and diligent post-operative care. These small skin bulges, which can appear at the ends of the surgical incisions, are often a result of excess skin or fat not being perfectly contoured.
Understanding "Dog Ears"
"Dog ears," medically known as redundant tissue, are small folds or puckers of skin and sometimes fat that can form at the edges of an incision. In the context of top surgery, they typically appear at the outer ends of the horizontal incisions across the chest. While generally harmless, they can be a cosmetic concern for some individuals.
Key Strategies for Prevention
Preventing dog ears is a multi-faceted process that begins even before surgery and continues through recovery.
1. Choosing an Experienced Surgeon
The most critical factor in avoiding dog ears is selecting a board-certified plastic surgeon with extensive experience in top surgery. An experienced surgeon possesses:
- Anatomical Understanding: A deep knowledge of chest anatomy and how skin and fat will behave post-surgery.
- Surgical Precision: The ability to meticulously remove the precise amount of skin and fat, and to close incisions without creating excess tissue at the ends.
- Contouring Skills: Expertise in using techniques like liposuction to feather the edges of the mastectomy area into the surrounding body, ensuring a smooth transition.
2. Pre-Operative Preparation
Patient preparation plays a significant role in achieving optimal surgical outcomes and minimizing the risk of dog ears.
- Maintaining Ideal Weight: Being at or near your ideal weight before undergoing a double incision mastectomy can greatly influence the success of the procedure in terms of aesthetics. While having excess body weight does not guarantee the development of dog ears, a healthier weight can reduce the risk. This is because significant weight fluctuations post-surgery can impact skin elasticity and overall contour.
- Quit Smoking: Smoking impairs circulation and the body's healing process, increasing the risk of complications and potentially affecting the final aesthetic result.
- Overall Health: Being in good general health, free from uncontrolled chronic conditions, supports better healing and reduces surgical risks.
3. Intra-Operative Techniques
During the surgery, specific techniques employed by the surgeon are crucial for preventing dog ears.
- Strategic Incision Placement: The surgeon plans incisions carefully to align with natural body contours and minimize excess skin at the ends.
- Liposuction: Often, liposuction is used in conjunction with the double incision technique to remove excess fat from the sides of the chest, under the arms, and along the back. This helps to achieve a smoother, more masculine contour and feather the edges of the treated area, directly addressing the potential for dog ears caused by fatty tissue.
- Tension-Free Closure: Closing the incisions with appropriate tension, distributing it evenly along the incision line, prevents puckering at the ends.
- Excising Redundant Tissue: Skilled surgeons are adept at identifying and excising small amounts of excess skin at the incision ends during closure, often using a technique called "M-plasty" or "dog ear excision" to prevent them from forming in the first place.
4. Post-Operative Care
Adhering strictly to your surgeon's post-operative instructions is vital for proper healing and optimal results.
- Compression Garments: Wearing your compression binder or vest as directed helps reduce swelling, applies even pressure to the surgical area, and supports the new chest contour, aiding in skin adherence and minimizing fluid accumulation that could distort the shape.
- Activity Restrictions: Avoiding strenuous activities, heavy lifting, and excessive arm movements for the recommended period prevents stress on the incisions and allows for proper healing.
- Lymphatic Massage: Once cleared by your surgeon, gentle lymphatic massage around the incision areas can help reduce swelling and improve lymphatic drainage, potentially minimizing the appearance of any minor irregularities.
- Patience: Healing is a gradual process. The final results of your surgery may not be fully apparent for several months as swelling subsides and tissues settle.
What if Dog Ears Still Occur?
Despite the best preventative measures, sometimes small dog ears can still form due to individual healing characteristics, skin elasticity, or residual tissue. If they are a significant concern once the swelling has resolved (typically 6-12 months post-op), a minor revision surgery can often be performed to remove the excess tissue and refine the contour. This is usually a quick outpatient procedure.
By working closely with an experienced surgeon and following all pre- and post-operative guidelines, you can significantly reduce the likelihood of developing dog ears and achieve the best possible aesthetic outcome from your top surgery.
