Shoulder narrowing surgery is an aesthetic procedure in which the incision and its final appearance has significance. While in fracture repair a long incision is used across the front of the clavicle with a significant scar, such an approach scarring in shoulder narrowing would not be acceptable to most patients. (even though it makes the surgery a lot easier) As a result a much shorter and more ‘hidden’ incision is its ed behind the clavicle in the supraclavicular fossa.
The supraclavicular fossa is a triangular depression above the clavicle at its inner half in the lower neck. Its almost right angle triangular borders include the sternocleidomastoid muscle medially, the clavicle bone inferiorly and the trapezius muscle laterally. Because it is an indentation a small incision can be placed behind the clavicle at its base for access to perform the bone removal. I can’t say that it is completely hidden but at least it is better than putting it own the front side of the clavicle bone.
In making the supraclaviclar fossa incision the logical approach would be to make it behind the bone but parallel to it. While there is nothing wrong in that placement that does not make it exactly match the relaxed skin tension lines (RSTL) of the skin in the lower neck. It is well known that placing an incision along the RSTL gives the best chance for the least amount of incisional scarring. By angulating the incision to make it in a natural skin crease this does not decrease access to the bone or make the surgery limited in any way.
The skin incisions are always covered with glued on tapes which stay on for as long as the glue holds…which is always at least 3 weeks or longer. This not only avoids the need for any patient care immediately after surgery but they also provide early occlusive scar therapy. When the tapes get loose they are removed and the positive early scar appearance is encouraging.
While the most important aesthetic outcome in shoulder narrowing surgery is at the outside of the shoulders the appearance of the scars to do so is not insignificant. The supraclavicular incision is at risk for adverse scarring in general as the amount of work that needs to get done inside a 4cm length places a lot of stretch and stress on the skin edges. Any anatomic advantage such as RSTL placement helps mitigate that potential adverse scar effect.
Barry Eppley
World-Renowned Plastic Surgeon