Novel Use of Disposable Negative-Pressure Wound Therapy Devices Versus Traditional Tie-Over Bolsters for Free Nipple Grafting in Transgender Chest Masculinization Surgery
Nikita O. Shulzhenko, MD, Mikaela Kislevitz, MD, Jerette J. Schultz, MD, Jonathan D. Keith, MD, FACS.
Rutgers New Jersey Medical School, Newark, NJ, USA.
BACKGROUND: Free nipple grafting is a commonly used technique in chest masculinization surgery for patients with large and ptotic breasts. Full-thickness nipple areola complex (NAC) grafts are harvested and repositioned on the chest wall to create an aesthetically pleasing male-appearing chest. We present our experience with a novel technique of utilizing disposable negative-pressure wound therapy (NPWT) devices as free nipple graft bolsters and compare our outcomes to traditional tie-over bolsters.
METHODS: A retrospective chart review was performed between 2015 and 2020 of all patients who underwent chest masculinization surgery for gender dysphoria with subcutaneous mastectomy and free nipple grafting by the senior author (J.D.K). Patient demographics, bolster type, and complications were abstracted. Complications between traditional bolster and NPWT groups were analyzed. A p-value of < .05 was considered statistically significant. The operative technique for free NAC grafting with NPWT was described.
RESULTS: Sixty-nine (N = 69) consecutive patients were identified. Mean age was 26.3 (SD: 7.54) years and mean BMI was 28.5 (SD: 6.7) m3/kg. Thirty-two patients (46%) were treated with traditional tie-over bolster dressings and 37 patients (54%) were treated with disposable NPWT dressings. Average follow-up time was 115 days. One patient experienced total NAC graft loss (1.4%), six experienced partial NAC sloughing (8.6%), and four experienced NAC hypopigmentation (5.8%). Other complications included four hematomas (5.8%) and three seromas (4.3%). Patients with traditional tie-over bolsters experienced significantly more nipple hypopigmentation compared to those in the NPWT group (p = .027). BMI was significantly correlated with occurrence of nipple complications (p = .018). Observed fluid collection complications (i.e. hematoma and seroma) were less common in the NPWT group but did not reach statistical significance (p = 0.110).
CONCLUSIONS: A novel technique for the utilization of negative-pressure wound therapy as a bolster for free nipple grafts in chest masculinization surgery is described. Compared to traditional tie-over bolster dressings, disposable NPWT bolsters are associated with significantly decreased rates of NAC hypopigmentation without significantly increased rates of sloughing or total graft loss and may lead to an overall improved aesthetic result.
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