Shoulder reduction surgery works by accessing the inner third of the clavicle bone and reducing its length by a measured ostectomy. To do this requires an incision over the clavicle, which by one’s own feel, the soft tissue over the bone feels fairly thin. In reality it is much thicker than it feels.
Regardless, an incision is needed to do the surgery and the obvious place would be directly over the location of the desired bone segment removal. While this would be effective and provides the most direct access to the bone it is not the best place for the scar nor the best place to have it heal as well as possible.
Rather the best place for the incision in shoulder narrowing surgery is just above the level of the bone in the supraclavicular fossa. This is a soft tissue concavity located just over the clavicle. Technically this is the anterior section of the posterior triangle of the neck which is bordered most predominantly by the large sternocleidomastoid muscle medially.
While this incision location is a bit indirect from the bone it is more ‘hidden’ and the skin is thinner which favors the potential for a lower risk of hypertrophic scarring. The key to using the incision is to employ it like a ‘mobile window.’ Once past the full layer of the skin the incision is pulled over the bone and the remainder of the soft tissue separated down to the periosteum of the clavicle bone.
With an incision length of only 3.5cms the bone can be dissected out circumferentially and isolated for segment removal.
Plate fixation can then be applied to reapproximate the two ends of the cut bone and effectively reducing outer shoulder width. Between the dissection needed to expose the bone and for plate application there is some considerable traction placed on the skin edges which has already been pulled down over the bone. While this is not ideal for creating the thinnest possible scar line during healing, it still places the scar in a better location when out slides upward back into the supraclavicular fossa during final skin closure.
Dr. Barry Eppley