Joining top surgery scars in the middle of the chest is a technique requested by some patients to ensure chest flatness by taking out excess skin. If the appearance of a joined scar is not appealing to a patient, other techniques can be used to tighten skin and reduce the chance of dog ear formation. For example, surgeons can extend the incision under the armpit, use chest liposuction and/or curve the incisions upward in the middle of the chest.