Can dog ears be avoided?

Fascinating - I hate that they thought you'd have "better quality of life" with reconstruction - really?  this is YOUR decision.   Seems kind of rude to me. . . .am I missing something?

I'm not a good one to answer your question as I did have reconstruction.  The one thing that struck me on your post was this - maybe you do want to talk to PS to have him / her help avoid the dog ears / pads?  I have a much longer scar on one breast that was created by my PS for just that reason - to avoid, as they called it, a love handle . . .   just a thought.

Good luck Denise . . .I love your tenacity!

Breast surgeons are general surgeons, and they aren't necessarily trained or skilled in the aesthetic aspects of surgery.  Isn't it practical to consult with a PS, assuming your BS won't necessarily be able to produce the cosmetic quality you're looking for in your incisions?  I think it may also be realistic to expect a second surgery--a plastic surgery--to correct any cosmetic issues you aren't happy with.  If you happen to have a BS who is a decent plastic surgeon, and she can do what you want in one surgery--great.  But I don't think it usually happens that way.

I have to side with brcapooh in her defense of breast surgeons who try to refer their BC patients to plastic surgeons for a consult.

My breast surgeon did that, even though I had told her I did not want reconstruction.  I was having a left mastectomy, and she asked how sure I was that I did not want reconstruction.  I cited a high level of certainty -- maybe "90 - 95%" -- and she said, "If you are not 100% convinced, I'd like to have you meet with a plastic surgeon for a consult. That way, you'll know what the options are."  She offered the name of a PS she worked with routinely, and said her nurse could make an appointment if that was something I was willing to do. She emphasized that she did not mean to pressure me -- she just wanted to make sure I had "all the information."

I am an information junkie. Here was a doctor I liked and trusted (and who would be cutting on me in a week or so), offering to provide me with information she knew I might not ever need. The consult was free (my insurance covered it). And, I am really glad I didn't cancel that appointment.

The PS knew at the outset that I was probably not going to have recon -- he said that didn't bother him; he just wanted to be sure I knew what was available.  He and his nurse spent the next 2 hours with me and my husband, going over before-and-after photos, recon techniques, pros and cons, and all the risks.  He asked me lots of questions, and offered his recommendations.  He told me my BS was an "expert" with skin-sparing mastectomy, and he and she worked together "all the time" (which I already knew).

After all that, I told him I was still certain I did not want recon. He grinned and said, "That's okay -- I don't feel bad. I'm satisfied knowing that a patient is well-informed."  He gave me his business card and said to call any time if I changed my mind, up to the day before my scheduled surgery.

What I didn't realize until weeks later was that breast surgeons get a bad rap because of the number of mastectomies they do, and because a percentage of those women choose not to have recon. As brcapooh said, "studies" report that patients are not informed of their surgical options and are not aware of the variety of reconstructive techniques available to them. Our breast surgeons are blamed for that information gap because they're the ones who are supposed to make sure we understand all this. "Everybody" (whoever that is) assumes a woman would not willingly give up her breast, and would not decline to have it reconstructed if the option was available. I think that's why some of us felt pressured to have recon or at least to consider it more seriously than we'd liked.

As for dog ears... when my surgeon met with me in the pre-op cubicle, she asked, "What type of surgery are we doing today?".  I almost laughed -- she was letting me wait until the very last minute. I told her "mastectomy with no reconstruction. Ever."  I said I didn't want a flap of tissue left on my chest "just in case," to make recon easier if I changed my mind later.  "No dog ears, then?" she asked.  I said, "No dog ears -- I'd like a straight, flat, smooth scar line."  She said, "Okay, then. That's what we'll do."

I do have some poochiness under my arm, and I complained about that a couple of times. She checked it out, smiled sympathetically, and said, "I think that's just you."  She noted indirectly that I had some poochiness on my good side, too. She explained that, before she finishes the surgery, she has the anesthetized patient raised into a sitting position to see what the incision and chest will look like. She checks for extra tissue, tightness of the incision, "how everything will lie" afterward. She said they try hard to make it all smooth, but sometimes there is a bit of extra, unwanted tissue. In that case, she said, a PS can easily tidy things up later. She offered a referral to the PS if I was still bothered by the poochiness. I declined.

Whew. Long answer to a short question! Yes, conventional dog ears -- the flap of tissue that's sometimes left on the chest to make recon easier -- is avoidable. It's mostly extra skin, and it does not have to be there. But, sometimes there is a pouch of fatty tissue under the arm that's above the incision line and is harder to avoid. I suspect surgeons don't like to remove that healthy fat pad unnecessarily because it could contain lymph nodes.

 Sorry this is so long. I haven't had anybody to talk to, today!

otter

Denise, you will feel a strange sense of relief when those suckers come off. Trust me! I actually feel sexier now than I did before!! I get to feel all the gorgeous fabrics against my bare chest and it is so sensual. I never have to wear a bra again!! I even had to buy a formal gown as two of my kids got married. I had them tuck the boning into my chest area so there is a gentle poof but no cleavage of course. I felt pretty. Now when I see big-breasted women I think "MOO"....hehehehehhe

Denise, I guess I see Otter's point but I've also been offended to hear that I would have a better quality of life wtih reconstruction.  I (this particular person who is ME) would not.  My BS tried to get me to see a PS and did say I might need "scar revision," but did not push when I dug my heels in.

I'm very pleased with the result of my BMX in 7/2010.  No dog ears, very smooth scars.  My asymmetry is subtle and is because of what was required to get get clear margins.  She was able to put my scars pretty close to my infra-mammary folds, so they hide in the shadow of my pecs. 

I do know that it can be hard to avoid puckers and protrusions when the incision closed is not the one that is opened.  A scar from, for example, a knee replacement should lie flat - it was just one cut that was stretched a bit but then stiched back up.  A scar from a mastectomy is like taking a piece of cloth, cutting out a football shape, then trying to stitch the hole closed.   It's much more likely to pull and pucker.  I'm sure some of your result will depend on your particular anatomy.

What exactly are dog ears? I've heard them described differently..are they folds of skin or protruding flaps of skin?  I have both kinds (go me!).  Close to my underarm area, especially on my right side where I had the SNB right at the end of the incision line, my skin folds together for about 1 1/2 inches.  I have to separate the fold to wash and dry that area.  

In the middle of my chest, again at the end of my incisions I have these little poofs of skin (I call them my lil breasts).  Again the right side is larger than the left and they are very sensitive to touch.  There is no way that I can wear any sort of bra or foob w/o it hurting.

My BS told me that I have to give my chest area at least a year to heal, smooth out, etc. Then if I'm unhappy with the way it looks, a PS can revise it.  I really do not want any additional surgery.

Cats 

My breast surgeon asked a plastic surgeon to assist him when I had my BMX.  I was very, very busty and didn't want to have reconstruction.  The plastic surgeon planned the incisions which run from my sternum to my underarms, along my infra-mammary fold (bra-line).  In addition, there are two T- scars, that run from where my nipples would have been to the longer scars.  No dog ears.   

I am *liking* this thread a lot!  So many very good questions and informative points-of-view.

otter (see, I can write a short post!)

Anytime I see a post about dog ears, I try to check it out.  This has been a fab read.  And RIANNE, I gotta tell you, you made my day.  This is because I have a dog ear under my arm, and at least I know could be if I keep massaging it, just like you did, perhaps it will smooth out. 

My dog ear under my arm is probably more properly called what another post said as a fat pad.  I had one breast removed, modified radical mastectomy, I chose not to have reconstruction.  When I first saw my scar situation, I noticed that fat pad, looked like a third mini-boob under my arm.  So, I stared at my other still-regular side and saw that the same extra fattiness was over there, but did not look strange because a boob was attached to it.  But if time and lotion and massage doesn't make it go down, I will have to have it removed, because I find it annoying to sleep on, and my underarm gets chaffed by it, and it really looks like a third boob!

I will go ahead and share my other stuff.  There were other dog ears on my scar, too, completely different from the fat pad dog ear under my arm.  These others were where the the skin simply puckered from more skin to fit in from top of incision than was at bottom of incision, leaving large puckers.  Now, a plastic surgeon would know how to make it fit neat, just as he will know how to get my fat pad dog ear off there.  

But anyway, my other dog ears were two.  There was the bubble dog ear of squeezed-in skin that showed up in the middle of my chest, at the beginning of the incision.  It was maybe the size of the end of my thumb... but other women report them as being much larger, too, and they really have a problem visually and comfort-wise.  Then, a little further in, I had a couple fold dog ears, which were folds that were longish bulges vertical to the scar, which I've described to others as looking like a three-year-old's effort to make a bed with hospital corners, by diagnoally tucking in wads of sheet as good as she might.  So, I guess you could call those fold dog ears.

Here is how they healed.  The bubble dog ear at the beginning of incision, amazingly enough disappeared as my skin settled down from being swollen and inflammed, and also I presume from daily applications of lotion and RIANNE's massage method.  Now, the fold dog ears, they settled down similarly, for the same reasons.  But I WILL say this, when I run my hand along my incision, I can still slightly feel where the bubble dog ear was and also where the fold dog ears were, as indentations.  But a man riding by on a fast horse wouldn't notice anything.  Smile.

I want to say something else, too, about some of the info that came up in this thread about how docs insist on getting reconstruction to ensure quality of life.  This is a perfect example of people being blind to what the original purpose of a law was.  You know how the Bible was removed from the hallways of that county courthouse in some town in Texas, I believe?  It was because some atheists jumped in and said "separation of church and state" meant the Bible couldn't be in a gov building.  Now, I'm not a die-hard Bible-thumping evangelist.  But I AM deeply religious, I mention the Good Shepherd often, and Christ's words weave through all parts of my life. 

So, when all that happened, I made a study of how in the world could the Constitution be so twisted and deranged by people with no imagination today, a Constitution that was written by some really God-fearing men in the 1700s who demanded religious freedom, since in England, religions other than those of the Crown were not permitted.  I found by reading some of Jefferson's papers that moving that Bible in Texas happened because judges misinterpreted the Constitution because they forgot the original reason for articles pertaining to church and state, which was the state could not limit our religious freedom, but would be NOTHING wrong with George Washington's Bible sitting on his own Presidential work desk!  But next thing you know, they'll take out all mentions of God in the Consitution itself, even tho they were written with pen and ink by the very makers of said document.

Sooooooo, if you can follow that, then this is exactly what has happened with breast reconstruction.  Originally, in our grandmothers' times, they had no choice for reconstruction... zip, no, nada.  So, in our last century, the era of women's rights, race rights, and war protestor rights, breast cancer survivors got together and petitioned our government to make it LAW that women have the right to not only get reconstruction, but to have it paid for by insurance.  And part of the plea was not only did a radical mastectomy ruin a woman's appearance, but it also ruined her quality of life, among other things.

But like the Bible in Texas, once the right was given, by golly medical providers and insurers, trying to abide by the law, managed to turn it upside down and exactly the opposite of what it was meant to be, it made it so we apparently at times have no right to reject reconstruction!  But in our grandmothers' times, just like us now, some women could care less about it, they didn't want more painful time-consuming surgeries, and thus the "reconstructionists" were those who DO want it and with good reason.  But what happens now is, in order to stay within the law "or else," the most assuredly twisted reasoning given to patients for reconstruction is it will give us better quality of life!  

And so the Bible gets moved in Texas and we must have reconstruction.  I hope you all have enjoyed my philosophical discourse in Logic 101 about how people can turn a perfectly sensible situation into taking the stripes off a zebra and giving it cow patches so starving Africans will have milk to drink.  Ha!

Love to all my sisters, GG

(1)  My intention was to have BMX - no recon - and I told that to my BS many times.  He still wanted me to see PS ... "just talk to him - see what he has to say".  I went for the appt - I still didn't want the recon.  *IMO* the BSs want you to consult w PS for two reasons - (a) I believe they think it should be 'standard of care' (b) > I think that if after your MX you are not happy w result ..... that the BS will not be blamed ... but that  the PS would!    I listened to what the PS had to offer ... declined.

(2)  fyi - I am very overweight - ok?  Before my BMX I was 44D .... Surgery was 12/20 - NOW I have  'dog ears' in the MIDDLE of my chest - flap looks like a 2" wide nipple!  Also I have gone from D breasts to A's on each side of me under my armpits!    THESE are 2 things I discussed/pleaded with my BS to not happen ... and to do EVERYthing he could to avoid!  

I have been debating/delaying posting my pics on the picture board ... but will soon .... mostly because so many wonder What do dog ears look like?  .. and What is the 'fluffiness' that some speak of.

I know I know ... I can address these with a PS at a later date ... but I'm afraid Insurance will say it's Plastic Surgery for asthetics and cost me more ... than to call it scar revision ... not to mention it's another surgery when I don't think I could have made my wishes known any clearer to my BS! 

I do know .. and I will Never forget though ..... I am Cancer Free!! (I'm #5 in my family with BC)

Hi again!  I just came here to correct something I said.  In my long post, in the paragraph before the one where I said Soooooooooo, I said soon they'll be taking out all mentioned of "God" in the Constitution.  However, recently I found that there are only a very few mentions, and none actually say, "God."  In the Declaration of Independence, "Creator" was mentioned twice, and I forget whether it's the Dec or the Con, but someone signed, "...in the year of our Lord... ," and then in the Articles to the Constitution where the discussion came from about separation of church and state, the word "religion" is mentioned, that its expression was not to be limited (or words to that effect).  This is perhaps a minor point when considering I was making an even more obscure point on how come people take laws and petitions for laws and turn original intent into some sort of new form that can be used against the very thing it was trying to convey.  All I wanted to do was show that this sort of thing goes on all the time, as in the case with the woman being pressured when incorrectly told her quality of life was at stake, since it also happens with the Constitution, when expression of freedom is actually compromised by misuse of the Articles themselves.  ANYWAY, I want to leave this topic forever, as I REALLY shoudn't have overstepped my bounds quite so far to begin with in my previous post, but thought it was amusing and striking enough that I could get away with it.  But apparently my detractors did not appreciate the explanation of why nurses might get it wrong and then unfortunately push a woman into doing something she didn't want to.  EVERYBODY has their reasons for doing the wrong thing, and I just wanted to make some statement that everybody gets confused sometimes.  And I'm also leaving this note here just in case someone does get what I was saying, but that I did make an error by saying that God was in the Constitution, which basically he is not because our forefathers didn't want to discriminate.  GG