The Angel Wings Incision: A novel solution for mastectomy patients with increased lateral adiposity

Abstract

Many techniques have been proposed to address the problem of increased lateral adiposity in patients undergoing mastectomy, however, there is no standard approach. This cosmetic deformity at the lateral end of the mastectomy scar, also known as a dog ear, is especially common in obese patients. This defect can be unsightly and uncomfortable. We describe a technique for creating a winged incision to eliminate the dog ear deformity. The Angel Wings Incision results in tissue flaps that create a smooth body contour upon closure in patients with increased lateral adiposity. The technique is reproducible, aesthetically pleasing, and improves patient satisfaction.

A Systematic Review of Cutaneous Dog Ear Deformity: A Management Algorithm

“…The literature search with our selected terms for dog ear management returned 2028 potential articles published between 1969 12 and 2019. 6 After excluding those that clearly did not involve human subjects, 561 remained. Of these, 481 articles were in the English language.…”

“…A common acquired surgical deformity requiring special consideration is the lateral breast dog ear, often discussed in the Breast and Plastic Surgery literature. 5 , 6 , 8 – 10 , 14 , 17 , 19 – 22 The first articles on this topic were published in 1988 8 , 21 and the majority focus on surgical management in post-mastectomy and post-mammaplasty, obese or large-breasted patients. 5 …”

“…Recently, Hill et al published a retrospective series of 112 mastectomy patients with lateral dog ears treated by angel wings incision. 6 Paired curvilinear incisions, “angel wings” are added lateral to the traditional mastectomy markings. The excision of lateral redundant tissue is performed first, followed by mastectomy.…”

“…The authors specify that operative note should dictate separate incision and tissue rearrangement. 6 …”

“… 5 – 7 For example, a lateral breast dog ear is frequently seen in breast surgery patients with a high body mass index (>30). 6 , 8 Such dog ears may cause chafing, a sensation of fullness or heaviness, interference with arm movement, and difficulty fitting a brassiere or clothing. 7 , 9 This issue may also be a source of litigation by disappointed patients.…”