A Novel Technique for Nipple Reconstruction to Improve Aesthetics in Chest Wall Masculinization Surgery
Samyd S. Bustos, MD1, Jorys Martinez-Jorge, MD1, Pedro Ciudad, MD2, Antonio J. Forte, MD, PhD, MS3, Oscar J. Manrique, MD1.
1Mayo Clinic, Rochester, MN, USA, 2Arzobispo Loayza National Hospital, Lima, Peru, 3Mayo Clinic, Jacksonville, FL, USA.
BACKGROUND: Chest masculinization-surgery improves quality of life and gender dysphoria in transmale and gender nonconforming individuals.Double incision mastectomy with free nipple grafts (DIFNG) offers more flexible nipple-areola complex (NAC) resizing and repositioning. Cis-male NAC has smaller diameter, oval shape and lateral position. If nipple grafts are performed without having these considerations, aesthetics can be dissatisfying. Current techniques address only the size and shape of the areola without appropriate modification of the nipple. Hereby, we describe the nipple split sharing technique during FtM chest surgery comparing surgical and patient-reported outcomes (PRO) and aesthetic results with the conventional technique. METHODS: Retrospectivereviewof transmalepatientswhounderwentdoubleincisionmastectomy and nipple sharing technique from January, 2018 to February, 2019.Regarding this technique, incisions and closure of the mastectomy flaps were performed in a standard fashion. The NACs were harvested as full-thickness skin grafts followed by splitting the complex through the middle, reducing the nipple and areola in half. Each half is brought and sutured in the midline creating a 2.5cm oval. The best split NAC graft was placed over the lateral border of the pectoralis muscle and 2 - 4 cm above the IMF. In addition PRO using Body-Q scale, aesthetic results using a Likert-based scale and complications were analyzed. RESULTS: Twenty-four patients (48 breasts) underwent double-incision mastectomy with bilateral free nipple grafting. Twelve breasts underwent this new technique for nipple reconstruction, whereas 36 underwent conventional bilateral free nipple grafting. Average patient age and BMI in the new technique group were 26.8 years and 32.2 kg/m2, whereas in the conventional technique group were 26.9 years and 32.7 kg/m2, respectively. Overall, average follow-up time was 8.2 months. Average mastectomy specimen weight was 602.7 g and 847 g for the new and conventional technique, respectively. None of the patients in the new technique group presented with major postoperative complications. Only one patient reported a hypertrophic scar over the inframammary incision. Patient satisfaction was 90.7% vs 58.1% in the new vs conventional technique, respectively (p<0.05). In addition, nipple’s masculine aspect, size, contour, position and scar was found to be aesthetically superior in the new technique group (p<0.05). CONCLUSIONS: Double incision mastectomy with nipple split sharing technique showed good aesthetic outcomes, low complication rate and high patient satisfaction. Longer patient follow-up and higher number of patients are required to confirm these outcomes.
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