Abstract P2-12-21: The “penny farthing” incision for mastectomy: A novel technique to reduce “dog ear” deformity and improve access to the axilla

Abstract

Abstract Introduction: Medial and lateral “dog ear” deformities are a common problem with mastectomy incisions. The challenges include different skin tensions superiorly and inferiorly and variable BMI. Also, the standard mastectomy incision is also not in the optimal place for sentinel node biopsy access. No published technique is universally applicable and some advanced techniques require excess dissection and operative time. Aims: 1) To perform a literature search for all published techniques 2) To pilot test a new, simple incision Methods: A literature search using PubMed was performed that revealed eight previous techniques (1). A new, simple technique was developed to incorporate most of the historical principles. Circles of different sizes are marked out medially (small) and laterally (large). The lateral circle incorporates the optimal position for access to the axilla for sentinel node biopsy or axillary clearance. These circles are joined by asymmetrical superior and inferior lines to encourage rotation during closure. Tumour size and position are taken into consideration. Wound closure begins from the centre which allows the wound to "choose" its own corners and tuck them inwards therefore minimising "dog ear" formation. Results: Seventy- five consecutive patients had the procedure by a single surgeon over an 18 month period. At the conclusion of each procedure there was no residual "dog ear" deformity at either wound end. Of the 36 patients seen for 12 month follow up only one (BMI 42) has required revision of the wound. Conclusion: The "Penny Farthing" incision is a novel, simple and promising technique to deal with "dog ear" deformity in mastectomy. Reference: 1. Thomas R, Mouat C, King B. Mastectomy flap design: the ‘waisted teardrop’ and a method to reduce the lateral fold. ANZ Journal of Surgery. 2012; 82: 329-333. Citation Format: Poole G, Sheikh L. The “penny farthing” incision for mastectomy: A novel technique to reduce “dog ear” deformity and improve access to the axilla. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-21.