Advocating for Enhanced Patient Engagement in Breast Cancer Care: Impact of Residual Increased Lateral Adiposity and Consideration of the Pursuit of "Living Flat"

Breast cancer is a significant health concern, accounting for a substantial proportion of cancer cases. Despite improvements in cancer survivorship, many women still require mastectomy as part of their therapeutic treatment. Mastectomy alone or delayed breast reconstruction (DBR) are two options available to women not suitable for immediate breast reconstruction at initial mastectomy. However, the presence of increased lateral adiposity (ILA) following mastectomy, commonly referred to as ``dog-ears,'' can lead to discomfort and aesthetic concerns. This paper explores the benefits and harms of ILA postmastectomy and its impact on patient satisfaction when choosing between mastectomy alone or DBR. A literature search was completed within OVID Medline, 1946-current, with the following terms, filtered for relevance: "mastectomy," "autologous reconstruction," "scar," "body image/dysmorphia," "patient-reported outcomes," "reconstructive surgical procedures/excess skin," "surgical flaps/dog ear." The disparity between clinical support and educational resources available for patients considering DBR options compared to those choosing mastectomy alone or pursuit of "living flat" is discussed. A common theme from qualitative research was the reported feeling of lack of inclusion in reconstruction planning by the patient. There were instances reported of residual skin remaining postmastectomy, against patient wishes. The findings emphasized the importance of shared decision-making and comprehensive preoperative education to ensure that patients are well-informed and satisfied with their chosen treatment approach. Further research is needed to address the specific needs and preferences of patients opting for mastectomy and to improve surgical techniques and education regarding living-flat options.

Correcting Flank Skin Laxity and Dog Ear Plus Aggressive Liposuction: A Technique for Classic Abdominoplasty in Middle-Eastern Obese Women

BACKGROUND

Nowadays obesity is a common problem as it leads to abdominal deformation and people's dissatisfaction of their own body. This study has explored using a new surgical technique based on a different incision to reform the flank skin laxity and dog ear plus aggressive liposuction on women with abdominal deformities.

METHODS

From May 2014 to February 2016, 25 women were chosen for this study. All women had a body mass index more than 28 kg/m², flank folding, bulging and excess fat, abdominal and flank skin sagging and laxity. An important point of the new technique was that the paramedian perforator was preserved.

RESULTS

All women were between 33 and 62 years old (mean age of 47±7.2 years old). The average amount of liposuction aspirate was 2,350 mL (1700-3200 mL), and the size of average excised skin ellipse was 23.62×16.08 cm (from 19×15 to 27×18 cm). Dog ear, skin laxity, bulging and fat deposit correction were assessed and scored in two and four months after the surgery.

CONCLUSION

Aggressive abdominal and flank liposuction can be safely done when paramedian perforator is preserved. This has a good cosmetic result in the abdomen and flank and prevents bulging in the incision end and flank. Using this abdominoplasty technique is recommended on patients with high body mass indexes.

Surgical techniques to avoid lateral dog ear of the mastectomy scar: A systematic review

INTRODUCTION

Mastectomy is commonly performed for breast cancer. However, a dog ear may arise at the lateral aspect of the mastectomy scar. This dog ear is not only unsightly but can also be a source of discomfort. While various surgical techniques have been reported to tackle this lateral dog ear, there is no standardized technique. We hence conduct the first systematic review of these surgical techniques with the aim of comparing the merits and limitations of each technique.

METHODS

A systematic literature search using the search terms "mastectomy scar", "mastectomy dog ear", "mastectomy lateral fold" and "mastectomy cosmesis" was performed. All relevant articles written in English and involving human subjects were included.

RESULTS

There were 2503 potentially relevant articles but only 12 articles met the inclusion criteria. The 'fish-shaped' incision or Y closure and its variations were the most commonly described techniques. Other techniques include the 'tear-drop' incision, 'L' scar technique etc. 'Fish-shaped' incision or Y closure is safe and provides good exposure to the axilla but its limitations are that of an additional scar and risk of skin necrosis at the apex of the Y incision. The other techniques attempt to eliminate the lateral dog ear while avoiding the complications associated with the 'fish-shaped' incision or Y closure.

CONCLUSION

Various surgical techniques to tackle lateral dog ear of the mastectomy scar have been described, each with its own merits and limitations. 'Fish-shaped' incision or Y closure is the most commonly described technique that has been prospectively assessed and was concluded to be safe.