FTM needs surgeon familiar with other techniques that eliminate 'dog-ear' deformity after mastectomy? (Photos)

Question

I am bigger chested and I have seen many 'dog ear' deformities from bigger chested FTM mastectomies. Some take their incisions back further which I am not interested in. After research I have noticed by finding a doctor that is familiar with "fish-shaped incision or tear-drop incision" that usually will elimate the issue I will have. All I am asking for is my incisions to avoid my main concern ; I would like this done within the next 4 months if I can find a certified surgeon with experience.

Jed H. Horowitz, MD, FACS · Answer

It's usually suggested to wait 6 to 12 months depending on the reason for a #revision and it's still early in your healing. The ideal technique best for you is difficult to determine online by photos alone. There are several methods used which depend upon the patient’s breast or chest #size before surgery. Considerations include the #laxity of skin, the #size of the #areola, the amount of #fat and recent weight #gain or weight #loss. 
The most common procedures include the #periareola, #buttonhole, #double incision, and #anchor patterns. I often use #liposuction along with the double #incision for larger breasts, and, some variation for smaller breasts; depending upon the position of the areola. The female breast nipple and #areola are often centered on the breast. However, the nipple and areola are lower and closer to the outside edge of the #pectoralis muscle in the male patient. Shaping the side of the chest may also be required and can be performed with #suctioning; along with contouring of the muscle, as noted above, to provide the best definition for the chest. A board-certified plastic surgeon with specialization is such breast procedures will #confirm the technique best suited for your revision during an in-person evaluation.

Keith M. Blechman, MD · Answer

In certain patients undergoing FTM top surgery, "dog ears" at the edges of the incision can occur.  This happens due to the presence of redundant skin at the edges of the breast.  The simplest way to remove dog ears are to cut them out during surgery, however this will lengthen the scar.  There may be doctors who use techniques with special names, but ultimately the dog ear is cut out is some way leaving some type of additional scar pattern. Sometimes, liposuction can help soften a dog ear, and then after a few months it can removed with a shorter scar. If it persists.A visit to a plastic surgeon's office will help you to understand what aesthetic outcomes are realistic in your particular case.  In order to get a qualified, ethical, and expert opinion on your surgical options and expectations, schedule an in-person office consultation with a plastic surgeon certified by the American Board of Plastic Surgery.
Best of luck,
Keith M. Blechman, MD
New York, NY

Brian Arslanian, MD · Answer

I would need to see you in person to say for sure, but based on these photos it looks like the best option for you would be to excise that excess skin using a standard extended incision that wraps under the arm and towards the back.  Most patients prefer having the scar over the not so pretty contour of having a large dog ear.  Unfortunately, that is really the only way to do it.  There are some variations in placement of the incision, but that typically only works with a small amount of excess tissue, so that is why an in person exam would be so crucial.  Another option is to liposuction the area and see if the skin will contract enough to make you happy.  If it doesn't then you would need to proceed with an excision procedure.  Good Luck"The above answer has been given without seeing this patient and cannot be substituted for actual in-person examination and medical advice; it is only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Emese Kalnoki, MD · Answer

Thank you for your question.
The problem that you brought up is a common one among FTM patients.  As the female body matures and if we gain weight, we often add this extra tissue (fat and skin) under the arms and around the back.  The reason for this is that the fold where your breast meets your chest wall does not end at the bottom of your breast, but rather is a tightness of tissue that goes around to the back.  So, as we gain weight, a lot of this fat bulges over that area.  To address this in Top surgery, it is best to address the breast tissue as well as the excess tissue on the sides.  If it is a small amount, than it can often be pulled up in a curved incision that follows the edge of the pectoralis major muscle.  If it is a large amount, than an incision may need to extend to the underarm area and onto the back.  It really depends on your anatomy.  Aesthetically, a scar is better than a bulge.  Good luck!

Sheldon Lincenberg, MD · Answer

The skin that stands up to form a dog ear at the end of a surgical scar behaves like that because there is extra skin beyond the scar. To be honest, since you have extra skin that wraps around the side of your chest on to your back, the only sure fire method to prevent a dog ear is to remove that extra skin. This technique is known as a chest plasty. For many patients, the scar is less of a concern than a bulging dog ear.

FTM needs surgeon familiar with other techniques that eliminate 'dog-ear' deformity after mastectomy? (Photos)

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FTM needs surgeon familiar with other techniques that eliminate 'dog-ear' deformity after mastectomy? (Photos)

Answers (7)

Answer: Taking care of dog ears after Top surgery

Answer: Taking care of dog ears after Top surgery

Answer: Prevent dog ear scars

Answer: Prevent dog ear scars

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Recommended reading

Everything you need to know about Masculinizing Top Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.