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7 Essential Facts About Top Surgery "Dog Ears": Causes, Prevention, And Latest Revision Techniques (2025)

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Undergoing top surgery is a transformative and life-changing step, but like any major surgical procedure, it comes with a specific set of post-operative considerations—one of the most common being the appearance of "dog ears." As of late 2025, the medical community and patient advocates emphasize that these small, localized folds of excess skin and fat near the ends of the surgical incision are a normal, often minor, and highly treatable side effect, primarily associated with the Double Incision (DI) Mastectomy technique. Understanding their cause, knowing the crucial waiting period for natural resolution, and being aware of the straightforward revision options can significantly reduce anxiety for those on their surgical journey.

This deep dive provides the most up-to-date information on top surgery dog ears, explaining exactly what they are, why they form, and the modern, minimally invasive solutions available to ensure you achieve the smooth, masculine chest contour you desire. Don't let this minor complication overshadow the success of your gender-affirming surgery; arm yourself with the facts.

Understanding the Phenomenon: What Exactly Are Top Surgery "Dog Ears"?

The term "dog ears" in plastic surgery, including transgender surgery, refers to small, triangular folds or puckers of skin and subcutaneous fat that can appear at the corners or ends of a surgical incision line. Following a double incision top surgery, these are most commonly seen at the lateral edges of the horizontal scar, often near the armpit or side of the chest. They resemble the folded-over corner of a page in a book, hence the common nickname.

While the term might sound alarming, dog ears are not a dangerous complication. They are essentially a minor contour irregularity that occurs when the amount of skin removed from the central chest area doesn't perfectly match the remaining skin tension at the edges of the closure. They are considered the most frequent reason for a revision procedure after a DI mastectomy.

The Anatomy of a Dog Ear: Skin, Fat, and Tension

Dog ears are composed of a combination of excess skin and, often, residual subcutaneous fat. The primary cause is a mismatch in the length of the incision closure relative to the amount of tissue removed. When a large amount of skin is removed—as is necessary in a mastectomy to achieve a flat chest contour—the surgeon must ensure the tension is distributed evenly across the entire incision line. If the incision isn't extended far enough laterally, or if there is localized excess tissue that wasn't fully contoured, the skin will bunch up at the ends, creating the dog ear.

Factors that can increase the likelihood of dog ears include:

  • Larger Chest Size Pre-Surgery: Patients with more significant pre-existing breast tissue and corresponding skin envelope often require more extensive skin removal, increasing the risk of uneven closure.
  • Pre-Existing Body Weight: Carrying extra weight can contribute to more residual fat in the lateral chest wall, which can exacerbate the appearance of a dog ear.
  • Skin Elasticity: Older skin or skin with poor elasticity may not contract as effectively during the healing process.
  • Surgical Technique: In some cases, the surgeon may be conservative with the incision length to keep the scars contained to the front of the chest, inadvertently increasing the risk of bunching at the sides.

The Crucial Waiting Period: Don't Rush to a Revision

This is perhaps the single most important piece of modern advice regarding dog ears: patience is mandatory. Many patients become concerned about these folds in the weeks or first few months following their top surgery, but the body’s natural healing process often resolves them without intervention.

Wait 6 to 9 Months: Plastic surgeons specializing in gender-affirming surgery strongly recommend waiting a minimum of six to nine months after the initial procedure before even considering a dog ear removal or revision surgery. This waiting period allows for several critical processes to occur:

  1. Natural Skin Contraction: The skin continues to contract and tighten over the underlying chest wall for many months. This natural process often smooths out minor irregularities.
  2. Swelling Resolution: Residual post-operative swelling, which can mimic the appearance of a dog ear, takes a long time to fully dissipate.
  3. Scar Maturation: The scar tissue needs to mature and soften before a secondary procedure can be accurately planned and executed for the best aesthetic outcome.

During this time, non-invasive management options are often encouraged, such as gentle massage techniques and consistent use of compression garments, which may help flatten and resolve minor folds.

The Latest in Dog Ear Revision Techniques (2025)

If, after the recommended waiting period, the dog ears persist and continue to bother the patient, a revision procedure is a simple, highly effective, and very common solution. The goal of this minor surgery is to refine the chest contour and create a smoother transition from the chest to the side of the body.

1. Simple Excision (Dog Ear Removal)

This is the most direct and common method. The procedure involves surgically removing the small, triangular piece of excess skin and fat. The surgeon then extends the original incision line slightly and closes the new incision, resulting in a slightly longer scar that is designed to lie flat and follow the natural curve of the chest/side.

  • Anesthesia: This is often performed as an outpatient procedure under local anesthesia, meaning the patient is awake but the area is completely numb. This makes the recovery significantly easier than the initial top surgery.
  • Recovery: Recovery is typically fast, with patients often returning to normal, light activities within a few days.

2. Excision with Complementary Liposuction

For dog ears where residual fat is a major contributing factor, the surgeon may combine the excision of the excess skin with targeted liposuction. This technique is used to remove underlying fat deposits in the lateral chest wall and armpit area, ensuring a smoother, more defined chest contour. This approach is particularly effective for patients with thicker subcutaneous tissue.

3. Z-Plasty or W-Plasty Techniques

While less common for simple dog ear revision, advanced techniques like Z-plasty or W-plasty may be used in complex cases or when the surgeon needs to specifically manage scar tension and direction. These techniques involve creating small, geometric flaps in the skin to break up the linear scar line, which can help distribute tension and further minimize the chance of a recurrence or a noticeable scar. However, for most standard dog ears, a simple extension and closure is sufficient.

5 Post-Operative Care Tips to Optimize Contour and Healing

While the formation of a dog ear is largely dependent on the initial surgical technique and your body's unique healing response, diligent post-operative care can significantly optimize your final chest contour and minimize any irregularities.

  1. Consistent Compression: Continue to wear your compression garment or binder as directed by your plastic surgeon. Compression helps reduce swelling and encourages the remaining skin to adhere smoothly to the underlying chest wall.
  2. Scar Massage: Once cleared by your surgeon (usually after 4-6 weeks), regular, gentle massage of the incision lines can help break down early scar tissue and encourage the skin to flatten, potentially aiding in the resolution of minor dog ears.
  3. Maintain a Stable Weight: Significant weight fluctuations, particularly weight gain, can cause fat deposits to form or increase in the lateral chest area, making any existing dog ears more prominent.
  4. Avoid Heavy Lifting: Follow all restrictions on physical activity. Excessive strain or pulling on the surgical site can compromise the healing of the incision, which is crucial for a smooth contour.
  5. Communicate with Your Surgeon: If you are concerned about any aspect of your healing, including the development of dog ears, schedule a follow-up appointment. Early communication ensures you receive personalized advice and are on track for a potential revision at the appropriate time.

Dog ears are a common, minor, and easily corrected contour irregularity following double incision top surgery. They should be viewed not as a failure of the surgery, but as a small, final touch-up needed to perfect the chest contour. By waiting the necessary 6-9 months and utilizing the simple, effective revision techniques available today, patients can achieve an excellent, long-lasting aesthetic result from their gender-affirming surgery with minimal stress.

top surgery dog ears
top surgery dog ears

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