Nipple Sensation after Female-to-Male Gender-Conforming Mastectomy with Nipple Grafts
Alap U. Patel, BA1, Jose G. Christiano, MD2.
1University of Rochester School of Medicine, Rochester, NY, USA, 2University of Rochester Medical Center, Department of Surgery, Division of Plastic Surgery, Rochester, NY, USA.
BACKGROUND: Female-to-male gender-conforming mastectomy with nipple grafts (GCMNG) can provide transgender individuals with a masculine-appearing chest and ultimately improve their quality of life.1 However, loss of nipple sensation has historically been an expected shortfall of nipple grafting. Although there are no data on the post-GCMNG population, some can be extrapolated from patients after breast reduction wit nipple grafting, with the largest series reporting complete loss of sensation in 90% of patients.2 Our study’s goal was to describe the rates of self-reported nipple sensation after GCMNG in our population. METHODS: A series of 56 outpatients undergoing FTM GCMNG over a 19-month period self-reported nipple sensation on a patient-reported outcomes tool preoperatively and postoperatively at 1, 3, and 6 months. Respondents rated sensation as either 1 (no sensation), 2 (a little bit), 3 (some), 4 (quite a bit), or 5 (normal). RESULTS: Fifty-six participants, with an average age of 25 years, had 112 FNGs and completed preoperative surveys describing nipple sensation before and after bilateral GCMNG. Preoperatively 21.43% of respondents said there was no nipple sensation or a little bit, 19.64% said some sensation, and the majority said there was quite a bit of sensation or normal sensation. The number of individuals saying they had no sensation or a little bit postoperatively decreased from 66.67%, to 61.54%, to 38.89%, at 1, 3, and 6 months respectively. Additionally, the individuals with quite a bit or normal nipple sensation postoperatively increased from 16.67%, to 23.08%, to 22.22% from 1 to 3 to 6 months respectively. CONCLUSIONS: Self-reported nipple sensation after GCMNG increases through at least six post-operative months. While loss of sensation is expected, our findings show that nipple sensation can be regained after surgery. Patients avoiding surgery due to concerns of nipple sensation loss should be counseled that the majority of patients have some to full nipple sensation within a short timeframe. Perceived nipple sensation in this population was better than in breast reductions as described by the literature.
References:
1 Agarwal CA, et. al. Quality of life improvement after chest wall masculinization in female-to-male transgenderpatients: A prospective study using the BREAST-Q and Body Uneasiness Test. J Plast Reconstr Aesthet Surg. 2018 May;71(5):651-657. Epub 2018 Jan 31. 2 Knox A, et. al. A Review of 101 Consecutive Subcutaneous Mastectomies and Male Chest Contouring Using the Concentric Circular and Free Nipple Graft Techniques in Female-to-Male Transgender Patients. Plast Reconstr Surg. 2017 Jun; 139(6):1260e-1272e.
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