الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
More than 1.6 million new cases of breast cancer are diagnosed worldwide each year making it the commonest female cancer worldwide. Surgery is the main line of treatment of breast cancer either breast conserving surgery or mastectomy. Because of different reasons, modified radical mastectomy still remains the treatment of choice in some women not eligible for less invasive techniques. Still up to half of all women diagnosed undergo a mastectomy as their primary surgical procedure. An additional group of patients goes on to completion mastectomy following unfavorable pathology results after initial breast-conserving surgery.
The oncological outcome is the first goal of breast cancer management, but the functional result and reduction of morbidity are also the indicators for quality of operative treatment. With the increasing interest in cosmetic out-come, more attention has been paid to optimize the mastectomy scar.
Following a standard mastectomy for breast cancer in obese and/or large sized breast patients, a fold of skin often persists at the lateral end of the scar lies at or above the bra line. Its actual incidence is unclear but appears to be a common clinical problem especially in the obese patients.
The redundant skin although it may not seem like a significant medical problem and can be considered minor morbidity, is not only cosmetically unpleasing and unsightly, the resultant excessive fat pad lateral dog-ears tend to hang over the top of the brassiere which can be an annoying problem to patients, cause discomfort, irritation and interfere with arm movement, wearing a brassiere or fitting an external prosthesis. It can be a source of long-term complaint that may even require surgical correction.
There are many techniques to tackle dog ear during mastectomy, but few prospective studies to assess those techniques. Fish shaped incision is the most commonly prospectively studied technique in the largest number of studies. But tear DROP incision and modified incision suturing were not evaluated enough in the past studies.
This study aimed to evaluate three of the common, easy and applicable techniques namely Y closure, tear DROP incision and modified incision suturing used to avoid the dog-ear deformity at lateral end of mastectomy scar regarding the efficacy to prevent the formation of dog-ear and patient satisfaction (cosmetic outcome and comfortability in wearing a brassiere or external prosthesis).
The study included 60 female patients who were obese (BMI>35) and/or had a large cup breast size (C or more) and expected to have a dog ear deformity after mastectomy, with exclusion of patient who took neoadjuvant chemotherapy. All patients were randomly selected into to equal groups according to type of dog ear deformity correction technique:
a. group (I): Fish tail technique (20 patients).
b. group (II): Tear DROP incision (20 patients).
c. group (III): Modified incision suturing (20 patients).
Summary
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It was found that fishtail, tearDROP and modified suturing techniques dealt well with the redundant skin lateral to mastectomy scar with no significant difference between the three techniques regarding their efficacy in prevention dog ear. While fish tail technique was significantly better regarding patient satisfaction, comfortability and doctor satisfaction than tear DROP and modified suturing techniques.