What can I expect in revision surgery for dog ears?

astyanax66

Hi, all,

I had a DMX in March and planned to go flat from the beginning. Although I am fairly flat in front, I have large, aching dog ears. My breast surgeon referred me to a plastic surgeon, who was onboard with aesthetic flat closure (not yet in the NIH lexicon in March, but there in late July). I'm scheduled for revision on Sept. 8. Everyone has said it's "so much easier" than the DMX (which wasn't awful, but wasn't much fun, either). What all can I expect? It's apparently day surgery with general anesthesia. I know the incision will go further back. How much pain? I admit I took pain meds for about a week after mastectomy (mostly because the drains hurt so much; felt pretty good after they came out). A nerve block wasn't available, which would have made things better (I don't think it's an option in this geographic region). Of course, all this depends on the current health situation.

So--walk me through it. ? Thanks!

Dee

virginiab

I had a dog ear removal almost exactly a year before you. I just had a single mastectomy, so only had one dog ear to correct.

The surgery was easy. My plastic surgeon also did a bit of liposuction to tidy up the area around the surgical field. She was able to get that approved as being part of the dog ear surgery. The surgery went easily. The scar followed my original mastectomy scar and went under my arm, where it turned up a bit and ended a couple inches below the fold of the armpit.

I did not need prescription pain killers, but took plenty of Tylenol. My doctors in the past have noted that I have a high pain threshold, so your use of pain meds may well be different from mine. I also used ice packs a few times in the first few days. I kept the chest wrapped in ace bandages until I went back for my follow-up appointment, which was 13 days later. At that appointment, my drain was removed and I was told I didn't need to keep using the compression wrapping. I had a single drain and did not have a lot of fluid going into the drain after the first day or two.

The doctor had given me a sheet of stick-on foam dressing to cushion the surgical area and I continued to use pieces of that for quite a while, generally under the upper edge of my bra near my arm.

For the first couple of days after the surgery, I spent most of my time resting/watching TV/reading, with some naps thrown in for good measure. Then I was ready to be doing more. I was careful to avoid lifting or raising the arm above shoulder height for the first two weeks.

I did use silicone strips on the scar for a month or two, although my surgeon said they were unlikely to be useful.

I am pleased with the end result.

I know your surgery is tomorrow and I hope you get a chance to see this today. I'll check in later in the day to see if you have specific questions.

astyanax66

I wrote a reply, and I think it vanished...thank you so much! I am doing pretty well, and it helped to hear what the process was like. I'm kinda a wimp on pain, but I have both Rx meds and an antibiotic all set up. I leave for the hospital in an hour. Thanks again, and have a great day!

Dee

akmom

I had revision surgery almost two years after BMX. Easier and faster recovery relative to BMX, and range of motion returned much more quickly. Like virginiab, I felt more comfortable with compression for the first while. There was some pain under one arm but it turned out to be a stitch that was kind of sticking out - once that little poky bit came off I was good. Hope you have a good experience and are happy with the results.

sideboobs

I had a DMX on Sept 8. Recovering well, except I did not anticipate requiring further surgery for the side boobs the surgeon so creatively left me. I am infuriated that he appeared to use me as a guinea pig for some new technique, without any prior discussion. My PT person is lovely, and has a lot of experience with mastectomy scarring, but has never seen anything like this. I still have temporary pain when changing positions. Not taking anything for pain, although this morning took an aspirin, as it just seems bad today. Have this constrictive feeling like a band about my chest all the time. Going on this chat was the first I heard the term dogears! I want to hear so much more about everyone else's experience. The surgeon actually tried to convince me the reason I ended up with side boobs, is because I had so much extra fat. I was never measured prior to surgery. Never knew it was something they do. Anyway, I was angry with that comment, and shot back with, "At what point was it a surprise how much chest fat I had?" I went in for surgery and came out a freak accident.

MinusTwo

Sideboob - I recall seeing discussion about this over several years. My suggestion would be to make an appointment with a different plastic surgeon for a consult & second opinion.

LivinLife

I had BMX without reconstruction on Aug. 31. That was always the plan once I made a decision about LMX or BMX. I had not heard about dog ears prior to this site either. I met with the BS first via a zoom appointment. I met with her another time in person 3 days prior to surgery when I had a lot of other pre-op appointments - my surgery was 4 hours away. The BS talked with me during the in person appointment about how she would do the incisions on my actual chest to avoid dog ears. I'm at the top end of my weight range though look like I weigh much less than that b/c I exercise - I'm not fit though in pretty good shape.

It sounded like she could avoid dog ears completely on my chest area. She then told me I would have much smaller dog ears under my arms b/c my weight, etc. and was ok.. My arms/armpits also get a lot of exercise - I use a push mower for a 1/2 acre, etc. She let me know most people are upset after surgery waking up to these underarm dog ears. She was making a point of letting me know what she can do is limited even if my area would be small. I appreciated her letting me know b/c I had seen pictures and heard of people's upset.

So I was able to see my incision about a week after surgery soon after the negative pressure wound vac was removed. My incision, instead of being the typical two incisions you would see around the boob area - plus of course the one for SNB - was instead all the way under one armpit all the way across my chest (no break) and completely under my other arm pit. I like this surgeon very very much and so figured there had to be a reason for this. I likely will not get the chance to talk with her b/c here we are a month later and she remains on medical leave. I trust her and believe this incision looks so different than what we discussed for 2 reasons - one being I have absolutely no dog ears anywhere! My upper chest area has always been on the tighter side anyways though we also talked about an aesthetically pleasing outcome. Additionally it seems (to me) that she really got as much tissue as she possibly could in all directions from my boob/chest area. I don't know if there was something she saw or it was precautionary but it kinds of looks like I got a face lift on 66%+ of my torso. I wasn't shocked by the incision at first per se tho it took some time thinking about and processing. I am fine with it today - am happy with the aesthetics and she did such a great clean straight job of the incision itself. It is healing nicely and will blend over time. The wound vac likely helped too.

To validate your point - surgeons, whether BS or PS, should talk with their patients about such things before surgery. What may remain, what they can or cannot do, are willing or not willing to do etc. They are the ones that know more than us about these kinds of things. You and me having no idea is likely not unusual. I would hope that would open up discussion options too. And the idea of your BS trying some new thing ithat turned out so upsetting to you is sooo not ok!! So sorry you are dealing with this while trying to recover. Breastfree.org has before and after pics of a dog ear revision. It may help you to visit that site to get an idea of what can happen. Of course it does mean another surgery.....

Also, I still have that "tight band" feeling around my chest. The "wad of dollar bills" feeling under my armpits is improving. From what I've read on different threads on this site these kinds of things are not unusual. It seems many of these things improve though whether it completely goes away varies. I can relate to others' posts about the band feeling like either always wearing a tight compression bra (front for me) and having duct tape wrapped tightly around the chest and back. I did just ask my PCP for a P.T. referral to help more with burning in parts of my arms when extending them up from my sides. I'm hoping it might help with other tightness, etc. too esp since I have scleroderma with some skin tightening. some of these things will improve and I/m realizing some may not. Others have mentioned wishing they had not waited to start P.T. My MO and PCP both told me I had to wait until the 6 week post-surgery mark to start P.T. though or still at risk for pulling incision area apart. My PCP also said something about time after all drains are removed too b/c that tissue still has to settle and heal. Whew! Sorry so long!

sideboobs

Thanks for your responses, esp. that long one, LivinLife. It means a lot to have a conversation with someone else. I started on some estrogen blocking pill from the oncologist. Dizziness and constipation. How can that possibly be helpful? Also since seeing the PT, my nerves around the incision went on rampage, and I now have horrible feelings at times around my sternum. I actually started holding the small mound of soft tissue in the middle, as when I am driving, if there is a side-to-side motion, it literally feels like my chest is a dryer with tennis shoes in it. I feel like an alien might pop out any minute. Been a hard week. I think my friends got tired of wishing me well for so long. I see the plastic surgeon day after tomorrow. They are also going to try to talk me into another axillary dissection, as my idiot surgeon apparently just did it for the billing. All three nodes he took were positive for cancer. Two were in my breast and one in the armpit. No pathologist in the wings. Very random sounding process. I'm supposed to look forward now, but I seriously don't want any more surgery. My trust got all used up the first time. I have a hard time not getting anxious hearing grocery cart noise at the grocery store, The first time i went out to the store the clerk rattled the cart right in front of me, and I was sure she was going to hit me in the chest with it. Do you suppose there were noises like that during the surgery?

LivinLife

I sooo feel for what you are describing - feelings, trust loss and increased vigilance and reaction when in public. You have a lot going on physically, let alone all you are dealing with medically and emotionally. I can understand you not wanting more surgery. Know it is always an option if you change your mind.... I actually went without a PCP for about 7 years b/c of all that was missed and also what was not shared with me by the first two. It is important we are comfortable with and can trust in our providers... I wish you well with your journey, am glad you are on this site and hope you have enough support at home, friends, etc. too - so important with what you are dealing with let alone your journey ahead.....!