Fish-tail plasty: a safe technique to improve cosmesis at the lateral end of mastectomy scars

Background and aims: Redundant skin at the lateral end of a mastectomy scar can be unsightly and uncomfortable, especially in elderly obese patients. The aim of this study is to evaluate a technique of mastectomy wound closure designed to maximise cosmesis at the lateral end. Patients and methods: Thirty lateral skin flap advancements were performed in 28 patients. The procedure was performed primarily in 27 cases. In three cases a delayed scar revision was performed. Following anterior advancement of the skin overlying the latissimus dorsi muscle, two areas of redundant skin were excised and the wound closed in the shape of Y-plasty. Results: The patients’ mean age was 70.6 years (range 51–93) and the mean body mass index (BMI) 30.4 kg/m2 (range 21–35). The mean weight of the excised breast tissue was 1015 g (range 356–2003). The mean lengths of the two limbs of the Y-plasty were 5.3 cm (range 3–10). The mean length of the base of the flap was 8.3 cm (range 4–14). One patient developed a small area of skin necrosis at the apex of the Y-plasty. Two further patients developed superficial wound infections. Conclusion: Fish-tail plasty is a safe and easy technique and may be recommended following mastectomy in obese patients to improve cosmesis and avoid discomfort caused by redundant skin.