A novel and easily reproducible technique for determining nipple placement in chest masculinization surgery

Abstract

The rate of chest masculinization surgery for gender affirming purposes is increasing in the United States. This rise in popularity can be attributed to greater awareness of the needs of the transgender population and improved insurance coverage for gender affirming care. 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 2 Cohen W.A. Shah N.R. Iwanicki M. et al. Female-to-Male Transgender Chest Contouring: A Systematic Review of Outcomes and Knowledge Gaps. Ann Plast Surg. 2019; 83: 589-593https://doi.org/10.1097/SAP.0000000000001896 Crossref PubMed Scopus (21) Google Scholar Although there is a growing body of literature detailing techniques, algorithms, and outcomes of chest contouring, relatively little attention has been paid to management of the nipple-areolar complex (NAC). 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 3 Agarwal C.A. Wall V.T. Mehta S.T. et al. Creation of an Aesthetic Male Nipple Areolar Complex in Female-to-Male Transgender Chest Reconstruction. Aesthetic Plast Surg. 2017; 41: 1305-1310https://doi.org/10.1007/s00266-017-0935-7 Crossref Scopus (24) Google Scholar , 4 Canner J.K. Harfouch O. Kodadek L.M. et al. Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States. JAMA Surg. 2018; 153: 609https://doi.org/10.1001/jamasurg.2017.6231 Crossref PubMed Scopus (162) Google Scholar In comparison to surgery for cisgender males, the neo-NAC for transgender males is formed from a NAC which tends to have a larger areola, more prominent nipple, and different anatomic location. Incorrect positioning of the NAC (most often too high and too medial) is a common pitfall in chest masculinization surgery. 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 5 Lane M. Ives G.C. Sluiter E.C. et al. Trends in gender-affirming surgery in insured patients in the United States. Plast Reconstr Surg - Glob Open. 2018; 6https://doi.org/10.1097/GOX.0000000000001738 Crossref Scopus (93) Google Scholar Management of the NAC in chest masculinization surgery additionally requires understanding the dynamic response of the body to the chosen techniques. This is influenced by multiple factors including the breast size, excess skin, degree of ptosis, and pre-operative positioning of the NAC.