Triangular Advancement Flap versus Fish-tail Plasty to Avoid Dog Ear Deformity at the Lateral End of Mastectomy Scar

Rabie Ramadan^1, , Moustafa R. Abo Elsoud² and Mohamed Alhashash²

¹Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt

²Department of Surgery, Medical Research Institute, Alexandria University, Egypt

Cite this paper:
Rabie Ramadan, Moustafa R. Abo Elsoud and Mohamed Alhashash. Triangular Advancement Flap versus Fish-tail Plasty to Avoid Dog Ear Deformity at the Lateral End of Mastectomy Scar. Journal of Cancer Research and Treatment. 2022; 10(1):23-29. doi: 10.12691/jcrt-10-1-3

Abstract

BACKGROUND: Breast cancer is the most frequent cancer among women. Different surgical techniques are being used for management of breast cancer whether CBS or mastectomy. More than half of women diagnosed with breast cancer undergo mastectomy whether as a primary surgical procedure or as a completion mastectomy Dog ear at the lateral end of mastectomy scar can cause poor cosmetic results, and discomfort so; there are many techniques to prevent its formation as the best method for treatment of dog ear after mastectomy is avoidance of its occurrence. This study aimed to compare the triangular advancement flap technique with the fish-tail plasty technique regarding the feasibility of the technique, avoidance of dog ear deformity formation at the lateral end of mastectomy scar, surgeons’ satisfaction and patient’s satisfaction and comfrtability. PATIENTS AND METHODS: This study included sixty obese and/or large- breasted female patients with breast cancer scheduled for MRM. Patients were randomly allocated into two groups: Group I included thirty patients underwent fish-tail plasty technique and Group II included thirty patients who underwent triangular advancement flap technique. Patients were followed up for the incidence of dog ear deformity, surgeon satisfaction and patient’s satisfaction and comfortability. RESULTS: Both techniques were feasible in performance with good exposure of axilla and good achievement of patient’s comfortability. The triangular advancement flap technique was associated with lower incidence of dog ear, fewer wound complications and shorter operative time but it had a longer scar length. Patients and surgeons satisfaction were significantly more satisfied in G II in comparison to G I (P= 0.001 and 0.015 respectively). CONCLUSION: Triangular advancement flap technique is effective, feasible technique for prevention of dog ear at the lateral end of mastectomy scar with lower incidence rate of dog ear formation, shorter operative time, lower incidence of flap necrosis and wound dehiscence and better patients and surgeons satisfaction when compared with fish-tail plasty technique.

Keywords:
breast cancer surgery modified radical mastectomy dog ear fish-tail plasty triangular advancement flap

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References:

[1]	Azim HA, Ibrahim AS. Breast cancer in Egypt, China and Chinese: statistics and beyond. J Thorac Dis. 2014; 6(7): 864-6.
[2]	Zervoudis S, Iatrakis G, Mares P, Boileau L, Grammatikakis I, et al. Breast conserving surgery in multicentric breast cancer, preliminary data of our experience. Eur J Gynaecol Oncol. 2014; 35(5): 530-4.
[3]	Curado MP. Breast cancer in the world: incidence and mortality. Salud Publica Mex. 2011; 53(5): 372-84.
[4]	Szynglarewicz B, Matkowski R, Kasprzak P, Halon A, Szelachowska J, Forgacz J, et al. Mastectomy approach with Y-shaped incision: a technique designed for women with obesity. Int J Gynecol Cancer 2009; 19(8): 1454-8.
[5]	Maged Hussien, Daltrey IR, Dutta S, et al. Fish-tail plasty: a safe technique to improve cosmesis at the lateral end of mastectomy scars. The Breast 2004; 13: 206–9.
[6]	Aitsi-Selmi A, Chandola T, Friel S, Nouraei R, Shipley MJ,et al. Interaction between education and household wealth on the risk of obesity in women in Egypt. PLoS One. 2012; 7(6): 11.
[7]	Bennett IC, Biggar MA.A triangular advancement technique to avoid the dog-ear deformity following mastectomy in large breasted women. Ann R Coll Surg Engl. 2011; 93: 554-5.
[8]	Jaber O, Vischio M, Faga A, Nicoletti G. The three-bite technique: a novel method of dog ear correction. Arch Plast Surg 2015; 42(2): 223-5.
[9]	Huizum MAV, Hage JJ, Oldenburg HA, Hoornweg MJ. Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer. Arch Plast Surg. 2017; 44(6): 502-8.
[10]	Loh CY, Loh AY, Mashhadi SA.A novel method for repairing the dog ear. J Plast Reconstr Aesthet Surg. 2013; 66: 341-2.
[11]	Nowacki MP, Towpik E, Tchórzewska H. Early experience with ‘fishshaped’ incision for mastectomy. Eur J Surg Oncol. 1991; 17: 615-7.
[12]	IC Bennett, MA Biggar. A triangular advancement technique to avoid the dog-ear deformity following mastectomy in large breasted women Ann R Coll Surg Engl 2011; 93: 551-7.
[13]	Lim GH, Tan HF. Surgical techniques to avoid lateral dog ear of the mastectomy scar: a systematic review. Int J Surg. 2016; 26: 73-8.
[14]	Szynglarewicz B, Matkowski R, Kasprzak P, et al. Mastectomy approach with Y-shaped incision: a technique designed for women with obesity. Int J Gynecol Cancer. 2009; 19: 1454-8.
[15]	Farrar WB, Fanning WJ. Eliminating the dog-ear in modified radical mastectomy. Am J Surg. 1988; 156: 401-2.
[16]	Thomas R, Mouat C, King B. Mastectomy flap design: the 'waisted teardrop' and a method to reduce the lateral fold. ANZ J Surg. 2012; 82(5):329-33.
[17]	Nowacki MP, Towpik E. A fish shaped incision for mastectomy. Surg Gynecol Obstet. 1988; 167: 251-2.
[18]	Vilar-Compte D, Jacquemin B, Robles-Vidal C, Volkow P. Surgical site infections in breast surgery: case-control study. World J Surg. 2004; 28(3): 242-6.
[19]	Mirza M, Sinha KS, Fortes-Mayer K. Tear-drop incision for mastectomy to avoid dog-ear deformity. Ann R Coll Surg Engl 2003; 85: 131.
[20]	Devalia H, Chaudhry A, Rainsbury RM, Minakaran N, Banerjee D. An oncoplastic technique to reduce the formation of lateral 'dog-ears' after mastectomy. Int Semin Surg Oncol 2007; 4: 29.
[21]	Clough KB, Massey EJ, Mahadev GK, Kaufman GJ, Nos C, et al. Oncoplastic technique for the elimination of the lateral “dog ear” during mastectomy.Breast J. 2012; 18(6): 588-90.
[22]	Hill EL, Ochoa D, Denham F, et al. The angel wings incision: a novel solution for mastectomy patients with increased lateral adiposity. Breast J. 2019; 25: 687-90.
[23]	Schnur PL. Axillary skin flaps (dog ears). Oper Tech Gen Surg 2002; 4(3): 265-9.
[24]	Weisberg NK, Nehal KS, Zide BM. Dog-ears: a review. Dermatol Surg 2000; 26: 363-70.