Geok Hoon Lim, Hui Fuan Tan International Journal of Surgery

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Surgical techniques to avoid lateral dog ear of the mastectomy scar: A systematic review Geok Hoon Lim, Hui Fuan Tan International Journal of Surgery Volume 26, Pages 73-78 (February 2016) DOI: 10.1016/j.ijsu.2015.12.068 Copyright © 2016 IJS Publishing Group Limited Terms and Conditions

Fig. 1 Right mastectomy with an unsightly lateral dog ear. International Journal of Surgery 2016 26, 73-78DOI: (10.1016/j.ijsu.2015.12.068) Copyright © 2016 IJS Publishing Group Limited Terms and Conditions

Fig. 2 PRISMA flow diagram of included studies. International Journal of Surgery 2016 26, 73-78DOI: (10.1016/j.ijsu.2015.12.068) Copyright © 2016 IJS Publishing Group Limited Terms and Conditions

Fig. 3 ‘Fish-shaped’ incision or y closure. The lateral edge of the mastectomy wound, Point B, is stitched medially, usually at the anterior axillary line. This then creates 2 limbs, C and D where the redundant skin is excised, resulting in a final ‘fish-shaped’ or Y scar with elimination of the lateral dog ear. International Journal of Surgery 2016 26, 73-78DOI: (10.1016/j.ijsu.2015.12.068) Copyright © 2016 IJS Publishing Group Limited Terms and Conditions

Fig. 4 Tear-drop incision resulting in a linear scar. International Journal of Surgery 2016 26, 73-78DOI: (10.1016/j.ijsu.2015.12.068) Copyright © 2016 IJS Publishing Group Limited Terms and Conditions

Fig. 5 ‘Waisted teardrop’ incision (solid line) modified from the tear-drop incision (dotted line) by retracting the breast medially and laterally. Additional de-epithelisation advancement of the lateral flap can be done if necessary (not shown in the figure). International Journal of Surgery 2016 26, 73-78DOI: (10.1016/j.ijsu.2015.12.068) Copyright © 2016 IJS Publishing Group Limited Terms and Conditions

Fig. 6 Oncoplastic technique involving opposition of one third of the lateral inferior wound to halfway point of the superior wound. International Journal of Surgery 2016 26, 73-78DOI: (10.1016/j.ijsu.2015.12.068) Copyright © 2016 IJS Publishing Group Limited Terms and Conditions

Fig. 7 Triangular advancement technique involving a ‘D’ incision with a triangular area placed inferiorly and laterally. The superior flap is then advanced inferiomedially to eliminate the lateral dog ear. International Journal of Surgery 2016 26, 73-78DOI: (10.1016/j.ijsu.2015.12.068) Copyright © 2016 IJS Publishing Group Limited Terms and Conditions

Fig. 8 ‘L’ technique involving 2 oblique incisions with an optimal distance (A) of 2–3 cm between them at the axilla and a third horizontal incision in the axillary fold. The final result is an inverted ‘L’ scar with elimination of the lateral dog ear. International Journal of Surgery 2016 26, 73-78DOI: (10.1016/j.ijsu.2015.12.068) Copyright © 2016 IJS Publishing Group Limited Terms and Conditions