Nipple Sensation Research Articles

Evaluating the Impact of Breast and Nipple Sensation on Quality-of-Life after Nipple-sparing Mastectomy with Implant Reconstruction: Long-term Outcomes Utilizing Breast-Q

Evaluating the Impact of Breast and Nipple Sensation on Quality-of-Life after Nipple-sparing Mastectomy with Implant Reconstruction: Long-term Outcomes Utilizing Breast-Q

Preserving Nipple Sensitivity after Breast Cancer Surgery: A Systematic Review and Meta-Analysis.

As breast-conserving procedures become increasingly safe and viable options for surgical management of breast cancer, efforts have focused on assessing and optimizing patient-reported outcome measures (PROMs), such as nipple sensation. This study aims to evaluate the current understanding of nipple-areolar complex (NAC) sensation outcomes in breast cancer patients undergoing breast cancer surgeries, namely, nipple-sparing mastectomies (NSM), skin-sparing mastectomies (SSM), and lumpectomies. Articles including terms related to "nipple," "mastectomy," "sensation," and "patient-reported outcome" were queried from three databases according to PRISMA guidelines. Study characteristics, patient demographics, and surgical details were recorded. Outcomes of interest included objective nipple sensitivity testing and PROMs. Of 888 manuscripts identified, 28 articles met the inclusion criteria. Twelve studies (n = 578 patients) used objective measures to evaluate sensitivity, such as monofilament testing. Sixteen studies (n = 1785 patients) assessed PROMs through validated or investigator-generated surveys. Three of the included studies reported NAC sensitivity in patients who received NSM with neurotization (n = 203 patients) through a variety of techniques that used various grafts to coapt a lateral intercostal nerve to the NAC nerve stumps. Results of investigator surveys showed that of 1565 patients without neurotization, nipple sensation was maintained in 29.0% (n = 453) of patients. Of 138 NSM patients without NAC neurotization, SWM testing showed an average loss of protective sensation in the nipple (average SWM score: 4.7) compared to normal or diminished sensation to light touch in nonoperated controls (average SWM score: 2.9, n = 195). Of patients who underwent NSM with neurotization, one study (n = 78) reported maintenance of NAC sensation in 100% of patients, while another study (n = 7) reported average diminished protective sensation in the nipple (average SWM score: 3.9). Our study has shown that objective and patient-reported results of nipple sensitivity support nipple-sparing techniques as a viable option for preserving NAC sensation, although patients can expect a decrease in sensation overall. Neurotization of the NAC during NSM shows promising results of improved postoperative nipple sensitivity, though additional studies are warranted to confirm this finding. Variations between study methodologies highlight the lack of standardization in sensory testing techniques when evaluating NAC sensation.

Superomedial Pedicle Septum based Reduction Mammoplasty for Breast Hypertrophy

Background: Reduction mammoplasty is a technique used for treating women with breast hypertrophy, in addition to improving the appearance of these breasts. Hence, the corrections under this mammoplasty include functional and aesthetic outcomes, while preserving the vascularity and sensibility of the breasts. Aim : To evaluate superomedial septal-based reduction mammoplasty in patients with breast hypertrophy on Nipple Areola Complex (NAC) vascularity, sensibility and overall complications. Patients and Methods: A total of 29 patients with bilateral breast hypertrophy underwent reduction mammoplasty with the superomedial pedicle and septal perforated technique. The mean distance of SN-N was 36.9 cm on the right side and 37.4 cm on the left side. The mean distance transfer of nipple–areola was 18.2 cm for the right side and 18 cm for the left side. The mean excised tissue was 1283 g from the right side and 1240 g from the left side. Results: Postoperatively, the mean of SN-N was 21.5 cm for both the right and left side. A limited wound dehiscence occurred in four patients (13.8%), impaired nipple sensation occurred in three patients (10.1%), while infection was found in one patient (3.4%). Conclusions: In our study, using the superomedial pedicle and septal perforator provided a safe and reliable technique for treating patients with breast hypertrophy, including macromastia and gigantomastia. It minimized the risk of vascular compromise of the NAC. this technique was found to show minor complications and provide good aesthetic outcomes.

79. The Sensory Assessment After FTM Gender Affirming Mastectomy (SAFTY) Study

Purpose: The double-incision gender-affirming mastectomy with free-nipple graft (DM-FNG) is increasing in demand. One concern is sensation loss to the chest and nipple areolar complex (NAC); however, the extent of sensation loss is poorly understood. Therefore, this study aims to quantify the degree and timing of sensation return to the chest and NAC to improve counseling and expectations for patients. Methods: Participants are enrolled at consultations and post-DM-FNG follow-ups. Semmes-Weinstein Monofilaments, ranging from 1.65-6.50 mm, assessed light touch and pressure at standardized locations. Sizes up to 2.83, 3.61, and 4.31 represent normal sensation, diminished light touch, and diminished protective sensation, respectively. Test tubes filled with warm and cool water assessed temperature sensibility. Results: Sensory tests were performed on 16 preoperative and 29 postoperative patients. There were no significant differences in demographics and clinical characteristics. 100% and 89.7% of preoperative and postoperative patients correctly identified warm and cool stimuli, respectively (p=0.18).At different postoperative times, there is normal sensation in the upper chest (F1, G-H1, G-H2), but decreased sensation closer to the NAC (G3, H3, p=0.023-0.037). Patients less than a year postoperatively have significantly decreased sensation along the inframammary scar (A-C) (p=0.0006-0.003), mid-axillary line (D-D2) (p=0.014-0.048), and nipple (p=0.00037-0.002).For breasts that had more than 500 g resected, there were significant sensation decreases along the inframammary scar (B, C) (p=0.004-0.031), mid-axillary line (D-D3) (p=0.00016-0.015), and below the inframammary scar (A1-C1) (p=0.014-0.04), whereas breasts with less than 500 g resected had normal sensation at those locations.48.3% had absent nipple sensation postoperatively. Compared to preoperative breasts, postoperative breasts had significantly reduced nipple sensation at all times (p=0.00000037-0.018). For those who were able to sense any stimuli on their nipples, a thicker monofilament size was required (4.45-4.46, p=0.00037-0.002). Conclusion: Postoperative sensation is normal except on the nipple, inframammary scar, and mid-axillary line. The inframammary scar is located along the dermatome of the 4th intercostal nerve that is routinely resected in DM-FNGs. Patients with large breasts have gravitational traction injury of their intercostal nerves with concomitant binding due to gender dysphoria have decreased sensation at baseline, which may explain why those with larger resected weights have less sensation postoperatively. Those who retained nipple sensibility had diminished protective sensation, increasing their risk for pressure injury. Protection against temperature injury was preserved. Understanding how sensation returns will better align patient expectations with outcomes.

QS14. Neurotized Chest Masculinization for Improving Nipple Sensation: Survey Results

QS14. Neurotized Chest Masculinization for Improving Nipple Sensation: Survey Results

Long-term breast and nipple sensation after nipple-sparing mastectomy with implant reconstruction: Relevance to physical, psychosocial, and sexual well-being

The effect of postoperative sensation on quality-of-life (QoL) following nipple-sparing mastectomy (NSM) with implant-based reconstruction is not well described. We evaluated the impact of breast and nipple sensation on patient QoL by using BREAST-Q. Patients undergoing NSM with implant reconstruction from 2008 to 2020 were mailed a survey to characterize their postoperative breast and nipple sensation. BREAST-Q metrics were compared between totally numb patients and those with sensation. A total of 349 patients were included. Overall, 131 (38%) responded; response rates regarding breast and nipple sensation were 36% (N=124/349) and 34% (N=117/349). Median time from surgery to survey completion was 6 years. The majority had bilateral procedures (101, 77%), including direct-to-implant (99, 76%) and tissue expander (32, 24%) reconstruction. Regarding breast sensation, the majority of patients reported their reconstructed breasts as totally numb (47, 38%) or much less sensation than before surgery (59, 48%). Regarding nipple sensation, the majority of patients reported their nipples were totally numb (67, 57%) or had much less sensation than before surgery (37, 32%). Total numbness of reconstructed breasts resulted in a significantly lower chest physical well-being (mean score: 73.5vs. 81.2, respectively, P=0.048). Total numbness of postoperative nipple(s) resulted in significantly lower chest physical (mean score: 74.8vs. 85.2, respectively, P=0.007), psychosocial (mean score 77.4vs. 84.4, respectively, P=0.041), and sexual well-being (mean score: 55.7vs. 68.3, respectively, P=0.002). Long-term breast and nipple sensation are significantly diminished after NSM with implant reconstruction. Patients with preserved sensation experience better physical, psychosocial, and sexual well-being.

P149. EVALUATING THE IMPACT OF BREAST AND NIPPLE SENSATION ON QUALITY-OF-LIFE AFTER NIPPLE-SPARING MASTECTOMY WITH IMPLANT RECONSTRUCTION: LONG-TERM OUTCOMES UTILIZING BREAST-Q

PURPOSE: The effect of postoperative sensation on quality-of-life (QoL) following nipple-sparing mastectomy (NSM) with implant-based reconstruction is not well-described. We evaluated the impact of breast and nipple sensation on QoL using BREAST-Q. METHODS: Patients undergoing NSM with implant reconstruction from 2008-2020 were mailed a survey to characterize their postoperative sensation. BREAST-Q metrics were compared between totally numb patients and those with sensation. RESULTS: A total of 349 patients were included. Overall, 131 (38%) responded; response rates regarding breast and nipple sensation were 36% (N=124/349) and 34% (N=117/349). Median time from surgery to survey completion was 6 years. The majority had bilateral procedures (101, 77%), including direct-to-implant (99, 76%) and tissue expander (32, 24%) reconstruction. Regarding breast sensation, the majority of patients reported their reconstructed breasts as totally numb (47, 38%) or much less sensation than before surgery (59, 48%). Regarding nipple sensation, the majority of patients reported their nipples were totally numb (67, 57%) or had much less sensation than before surgery (37, 32%). Total numbness of reconstructed breasts resulted in a significantly lower chest physical well-being (Mean Score 73.5 vs. 81.2 respectively, P=0.048,). Total numbness of postoperative nipple(s) resulted in significantly lower chest physical (Mean Score 74.8 vs. 85.2 respectively, P=0.007), psychosocial (Mean Score 77.4 vs. 84.4 respectively, P=0.041), and sexual well-being (Mean Score 55.7 vs. 68.3 respectively, P=0.002). CONCLUSION: Long-term breast and nipple sensation are significantly diminished after NSM with implant reconstruction. Patients with preserved sensation experience better physical, psychosocial, and sexual well-being.

A Cross-sectional Study of Nipple and Areola Sensation after Female to Male Subcutaneous Mastectomy Comparing between Semicircular, Concentric Circular and Free Nipple Graft Techniques

Background: Subcutaneous mastectomy is one of the most common procedure in Female to Male transexualism. The sensitivity of nipple-areola-complex (NAC) postoperatively is still unclear. Objective: To evaluate nipple-areola-complex (NAC) sensation after female to male subcutaneous mastectomy comparing between semicircular, concentric circular and free nipple graft techniques. Materials and Methods: The present study included 47 patients who underwent subcutaneous mastectomy (MG) with semicircular (SC, n=6), concentric circular (CC, n=17) and free nipple graft technique (FNG, n=24). NAC sensitivity was assessed for touch, pain, cold temperature, erogenous sensation and nipple erection. Results: The most sensation patients concerned is touch sensation (58%), pain (18%), erogenous/erection (8%) and cold (7%). For touch sensation SC and CC still had touch sensation but 27% of FNG had loss touch sensation (p=0.001). For pain sensation SC and CC still had touch sensation but FNG had lost pain 33% at areola and 23% at nipple (p<0.001). For cold sensation 12% of CC and 25% of FNG had lost cold sensation at areola (p<0.001) and 12% of CC and 9% of FTG had lost cold sensation at nipple (p<0.001). For erogenous sensation 50% of SC, 35% of CC and 77% of FNG had lost erogenous sensation. For nipple erection 50% of SC, 35% of CC had erect but no nipple erection in FNG. Conclusion: All sensation parameters of NAC. SC is better than CC and FNG is the worst. The most sensation patients concerned is touch sensation. Keywords: Nipple and areola sensation; Female-to-male subcutaneous mastectomy; Free nipple graft; Nipple sensation; Subcutaneous mastectomy

Layered Mastopexy with Augmentation in Muscle Splitting Biplane: A Modification for Lower Pole Safety and Stability.

Single-stage mastopexy with augmentation is a commonly performed procedure. The single-stage procedure can be performed in primary cases or a secondary procedure in patients with previous history of augmentation, mastopexy or mastopexy with augmentation. The procedure is challenging and not without its risks. A retrospective chart review of all consecutive cases of layered mastopexy with augmentation mammoplasties, carried out from September 2015 to August 2019, was performed. All patients had their implants placed in muscle splitting pocket first and access for the pocket was closed prior to the commencement of mastopexy. During the period of 4years, 102 consecutive layered mastopexy with augmentations were performed in muscle splitting plane. Of these 102 patients, 74 (72.5%) patients had it as a primary and 28 (27.5%) as a secondary procedure. Of these 102 patients, 53 (52.0%) had textured, 37 (36.3%) had smooth and 12 (11.8%) had microtextured implants and 72 (70.6%) patients had high profile and 30 (29.4%) had medium profile implants. Same size implant was used in 89 patients with a mean of 298cc, and 13 patients had different size implants with a mean of 362cc on the right and 395cc on the left. In current study, bilateral periareolar, vertical scar cat's tail and Wise pattern mastopexies were performed in 11, 51 and 27 patients, respectively. Of the 102 patients, 5 had unilateral right periareolar, 5 unilateral right vertical scar cat's tail, 2 unilateral left periareolar and 1 patient had a combination of periareolar and vertical scar combination. There was no nipple loss or periprosthetic infection. There was a minor wound breakdown seen in 4 (3.9%), haematoma in 2 (2.1%), nipple sensation loss in 2 (2.1%) and 12 (11.8%) had layered mastopexy as a part of a combined procedure. Revision was performed in 6 (6.5%), drains were used in 14 (13.7%), and 92 (90.2%) had the procedure performed as a day case. Layered mastopexy with augmentation is a safe procedure with added stability and safety to lower pole of the breast as well as nipple-areolar complex. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Safety of diathermy for pedicle de-epithelialization in breast reduction surgery in comparison to surgical blade use

ABSTRACT Background: Pedicle de-epithelialization during breast reduction is traditionally performed using a surgical blade. The reliability of this method is hampered by the time-consuming nature, bleeding and safety concerns. In this study, a comparison of the use of the surgical blade to the diathermy was assessed for blood loss, surgical time and safety during breast reduction procedures at two breast units in Johannesburg, South Africa. >Methods: Fifteen patients undergoing breast reduction procedures with a total of 30 breasts (n=15 each for diathermy and surgical blade) were reviewed. Surgical swabs were weighed for blood loss differences and procedures were timed. Postoperatively, nipple sensation and nipple viability were determined in all patients. The data was analysed using STATA Version 16.0 suite of analytics software and a p value of <0.05 was considered significant. Results: The participant ages ranged from 18-59 years with a mean (standard deviation) of 34.0 (±12.8) years. The median and interquartile ranges (IQR) of blood loss from using the surgical blade was significantly higher compared to that of the diathermy at 25.4 mL (11.4-49.4) mL versus 10.0 mL (4.0-20.0) mL, respectively (p=0.003). There were no significant differences in the overall time taken in performing the procedures: surgical blade 13.0 (11.0-21.0) minutes vs diathermy 12.5 (9.0-14.0) minutes (p = 0.27). Apart from a hematoma in one breast in the surgical blade arm, nipple viability was 100% and nipple sensation was 93.3 % (14/15) for both groups. Conclusion: Despite similar safety profiles between de-epithelialization using diathermy versus surgical blade, the added advantage of significantly lower blood loss using diathermy suggests that the latter be considered over the standard surgical blade method during breast reduction and other procedures involving flaps.

The New Concept of making the Excellent Result in Mastopexy

Background: Breast ptosis is one of the more common issues seen in cosmetic surgeons’ offices, particularly those performing a significant amount of aesthetic breast surgery. Patients with ptosis generally desire the same result – youthful and “perky” breasts. However, due to wide variations in breast volume and tissue quality, ultimate results vary with each patient, and as a result, preoperative management of expectations is critical. There are many surgical options that can be customized to patients’ needs, but these generally address repositioning of the glandular tissue and nipple areolar complex and management of skin excess. Scar patterns include circumareolar, circumvertical (including J or L scar variations), and inverted-T patterns. If author’s new concept can eliminate the remaining skin excess that occur from approximately preoperative markings of traditional mastopexy and can decrease the scar pattern (J or L scar variations and inverted-T patterns), they are interesting to bring an alternative to reduce complications and more satisfactory results. Objective: Author study the new concept of surgical techniques of mastopexy in severe ptotic breasts. The new concept is the changing steps of procedure that performs repositioning and reshaping of the glandular tissue and repositioning of nipple areolar complex before, follow by design and excise the excess skin flaps. Surgical result, main complications and patient satisfaction are evaluated. Methods: The study has performed in 11 patients who have severe ptotic breasts with author’s techniques of mastopexy since July 2017 to march 2018. The techniques including repositioning and reshaping of the glandular tissue and repositioning of nipple areolar complex, skin flaps are designed and excised accurately. Postoperative care makes as standard protocols. Results: Of 11 patients who underwent mastopexy with author’s techniques, all patients have symmetric, only short vertical scar and beautifully shaped breasts and 2 patients have superficial necrosis of skin which at junction of inferior edge of areola and vertical incision, both sides and right side respectively. Three breasts which have superficial skin necrosis, manage include death tissue was removed, dress wet wound every day and make delay primary wound closure in some areas. Nipple sensation is usually normal. Some patients have decrease sensation and fully recover within three months. Conclusion: Author’s surgical techniques change steps of standard mastopexy, as new concept for severe ptotic breast. Repositioning and reshaping of glandular tissue and repositioning of nipple areolar complex firstly, these will help surgeon design and excise the excess skin flaps more accurately. But surgeons do not over excise skin flap to prevent skin necrosis especially junction area. Accordingly, author’s technique can decrease frequent complications of mastopexy including asymmetry, improper of flap excision and undesired J or L, inverted T scar.

Minimally invasive treatment of gynecomastia by ultrasound-guided vacuum-assisted excision: report of a case series

Introduction: Gynecomastia (GM) is a benign proliferation of glandular breast tissue in men. Some cases need surgical intervention. Traditional open surgery by semicircular inferior periareolar incision is the most common surgical approach. In order to obtain better esthetic results, some alternatives to open surgery have been proposed, such as liposuction, endoscopic mastectomy, and vacuum-assisted excision (VAE). Objective: To describe the technical surgical approach of ultrasound-guided VAE of GM and its results from a case series. Method: This is an evaluation of seven GM cases submitted to ultrasound-guided VAE with a 10G needle using the ENCOR® BD whole circumference automated breast biopsy system in Redimasto – Redimama, a Brazilian breast center. The result was considered good or satisfactory when it showed minimal remaining gland, good symmetry, no retraction, necrosis, hypertrophic scar, or displacement of the nipple-areola complex. All patients answered a questionnaire to evaluate their satisfaction and perception of the procedure. Results: Seven (7) patients with Simon grade 1 and 2 bilateral GM underwent ultrasound-guided VAE. No case of displacement, necrosis, or retraction of the nipple-areola complex, post-procedure bleeding, infection, skin necrosis, or asymmetry was detected. No patient reported decrease or change in nipple sensation or erection. All patients had bruises and hematomas that spontaneously resolved within 30 days. All results were considered good or excellent by patients and surgeons. Conclusion: Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results, small scar, and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery.

Minimal Incision Technique For Gynecomastia

Background:Gynecomastia or enlargement of the male breasts affects a large proportion of males, with most patients requiring surgical intervention as only a few lesions are actually resolved with medical management alone. Surgery cures the patients of their problems, albeit, at the cost of scarring and other cosmetic problems in some patients. Therefore, refinements in the surgical process are still ongoing so as to provide the best results with minimal scarring.Aims and Objectives:To find out the feasibility of a minimal incision technique for glandular excision after liposuction in patients with gynecomastia so as to decrease the final visible scars in these patients.Materials and Methods:From July 2018 to September 2018, eight patients were subjected to gynecomastia surgery employing liposuction and gland removal through a single transverse 5–7 mm incision in the nipple. All the patients subjected to this technique had Grade IIa gynecomastia as per Simon’s scale. The Global Aesthetic Improvement Scale, comprising a 5-point Likert scale, was employed to find out the satisfaction level of the patients 12 months after surgery; this level was compared with that of a similar population of patients being operated on by employing liposuction and subcutaneous mastectomy by the periareolar technique.Results:The mean operating time was 110 min, and there was minimal bleeding during the procedure. Complications were also negligible, and all patients achieved an excellent chest contour with restoration of protective nipple sensation when evaluated 12 months after surgery. The difference in mean between the 2 patient groups was 0.125 with a p-value of 0.64.Conclusions:Glandular excision through a single transverse incision made through the nipple is a safe approach in selected patients and it produces excellent cosmetic outcomes. However, it requires patience on the part of the surgeon to achieve the desired goals of the surgery.

Immediate targeted nipple-areolar complex re-innervation: Improving outcomes in immediate autologous breast reconstruction

Breast reconstruction often renders the chest skin and nipple areolar complex (NAC) insensate. We propose a new technique of preserving the intercostal nerves during mastectomy and using them to reinnervate the NAC following mastectomy and immediate autologous tissue reconstruction. The technique involves preservation of the lateral intercostal nerves during mastectomy, dissection of the lateral intercostal nerves to length, coaptation of the intercostal nerves to a nerve graft which is then tunneled through the free flap and the distal nerve graft is then coapted to the nerve stumps at the base of the NAC. We performed a retrospective analysis of 14 breasts, which underwent nipple reinnervation during immediate autologous breast reconstruction. Mean age was 49 years (range: 32-61 years). Sensory outcomes, as tested with Semmes-Weinstein monofilaments, were compared to a cohort of breasts that underwent nipple sparing mastectomy without neurotization. Compared to control patients, there was no statistically significant difference (p = 0.0969) in sensation between pre-operative and post-operative nipple sensation at final follow-up. This proof-of-concept study suggests that immediate re-innervation of the NAC in the setting of immediate breast reconstruction enhances recovery of the NAC sensation.

054 Topical Alpha-1 Adrenergic Receptor Agonist Applied to the Nipple Areola Complex Significantly Improves Female Orgasmic Function

The impact of nipple sensation and its relationship to sexual function has often been neglected in medical literature. However, several recent studies report the importance of the nipple areola complex (NAC) in sexual arousal and overall function. The nipple is composed of smooth muscle that can be erected via adrenergic nerves. In two complementary studies, we demonstrate that stimulation of the alpha-1 adrenergic receptor in the NAC with topical adrenergic agents can initiate erection of the nipple, increase NAC sensitivity, and improve sexual function.

Topical Alpha-1 Adrenergic Receptor Agonist Applied to the Nipple/Areola Complex Improves Female Orgasmic Function.

Background: The impact of nipple sensation and its relationship to sexual function have often been neglected in medical literature. However, several recent studies report the importance of the nipple/areola complex (NAC) in sexual arousal and overall function. The nipple is composed of smooth muscle that can be erected via adrenergic nerves. In two complementary studies, we demonstrate that stimulation of the alpha-1 adrenergic receptor in the NAC with topical adrenergic agents can initiate erection of the nipple, increase NAC sensitivity, and improve sexual function. Materials and Methods: Thirteen breast surgery patients with nipple sensitivity loss were recruited to an unblinded study of topical phenylephrine hydrochloride. Sensitivity to pressure was measured before and after the application of the intervention to the NAC. In a second pilot study, 35 women completed a double-blinded placebo-controlled trial of a novel formulation, RJ101, containing a norepinephrine releasing agent. The intervention or placebo was applied to the NAC 30 minutes before sexual activity over the 4-week trial period. The arousal, lubrication, and orgasm domains of the female sexual function index (FSFI) were used to measure sexual function. Results: The application of phenylephrine hydrochloride was shown to increase nipple sensitivity to pressure by an average of 20% in our cohort of 13 breast augmentation patients. In addition, it was shown that intermittent application of the alpha-1 agonist for 8 weeks increased basal NAC sensitivity. In the follow-up pilot study, we demonstrate that stimulation of the NAC with RJ101 produced statistically significant increases versus placebo in the lubrication and orgasm domains of the FSFI, p = 0.0226 and p = 0.0269, respectively. Conclusion: For the first time, we demonstrate that the application of a topical alpha-1 adrenergic receptor agonist or a norepinephrine-releasing agent increases the sensitivity of the NAC and subsequently significantly improves sexual function.

A Comparison of Gender-Affirming Chest Surgery in Nonbinary Versus Transmasculine Patients.

Increasingly more nonbinary patients are obtaining better access for gender-affirming chest surgery (top surgery), representing an important subset of patients who undergo such surgery. We review our experience at gender-affirming chest surgery in nonbinary versus transmasculine patients in an integrated health care setting. We performed a retrospective study of nonbinary and transmasculine patients who underwent gender-affirming chest surgery from May 1, 2012, to December 27, 2017. There were 111 nonbinary patients and 665 transmasculine patients included in the final analyses. Nonbinary patients were more likely to seek more than 1 surgical consultations than transmasculine patients (24.3% vs 1.7%, respectively, P < 0.0001). More nonbinary patients (17.3%) indicated nipple sensation to be important relative to their transmasculine counterparts (0.4%, P < 0.0001). Fewer nonbinary patients were on testosterone before surgery (33.64%) in comparison to transmasculine patients (86.14%, P < 0.0001). When only prior reduction mammaplasty or top surgery were considered, nonbinary patients (8.1%) were more likely than transmasculine patients (3.5%) to have had a prior chest surgery. When evaluating patients who did not have prior chest surgery before undergoing top surgery at our institution (n = 721), rates of major complications, minor complications, as well as revisions, were comparable between nonbinary and transmasculine patients. This study demonstrated that more nonbinary patients requested nonflat chests relative to their transmasculine counterparts. Both groups in our sample displayed comparable rates of complications after top surgery.

Evaluation of concentric periareolar subcutaneous mastectomy outcomes in transsexual patients during 2016–2017 in Iran: A clinical study

Background: Transsexual (TS) people are those who assigned one sex at the birth but identified their gender in what society considers the opposite direction. Studies showed that gender reassignment surgery (GRS) had greatly improved the quality of life in TS patients. Materials and Methods: We studied 20 patients who had legally the permission of being underwent the sex reassignment surgery in Imam Khomeini Hospital Complex of Tehran, Iran. For all patients, concentric periareolar subcutaneous mastectomy was performed. The patients were followed up for 1 year and the results were evaluated. Results: Our findings show an acceptable scar formation after 1 year of the sex reassignment surgery. There was only one complication which was managed conservatively. About 90% of patients were satisfied from the results of surgery, and no one was less/unsatisfied. The average score of nipple sensation was 7.9 and no changes in nipple pigmentation was observed. Conclusion: Concentric periareolar mastectomy is probably a good technique of subcutaneous mastectomy in female to male GRS in patients with small and medium size of the breast and poor skin elasticity. The result scar in this method is acceptable and gives the patients a good feeling of having male chest.

Inferior and Central Mound Pedicle Breast Reduction in Gigantomastia: A Safe Alternative?

Background Gigantomastia has been described as excessive hypertrophy of the female breast, however, there is controversy about the weight of the excised tissue. In the literature, resected tissue amount between 1,000 g and 2,000 g per breast is reported as gigantomastia. Aims: The aim of this study is to evaluate the results of the patients who underwent reduction mammaplasty with a resection amount of at least 1,000 g or above via inferior pyramidal pedicle breast reduction technique retrospectively. Patients and methods: Between September 2015 and September 2018, 72 patients operated for gigantomastia were included in the study. All patients underwent reduction mammaplasty by inferior pyramidal pedicle and inverted Tscar technique. The pedicle base was not detached from the posterior region of the pectoralis fascia. Patient demographics, advantages, drawbacks and results of this technique were analyzed. All procedures were performed at a single institution by the senior author of this article. Results: The most common complication was hypertrophic scar (4.16%). At least 1-year follow-up revealed satisfactory results in terms of both esthetic and functional aspects. The average satisfaction rate was 88% (score: 4.38 = satisfied/very satisfied). Conclusion: Inferior pyramidal pedicle technique is a versatile reduction mammaplasty technique that can be applied in various breast sizes. It provides important advantages of preserving the nipple sensation and lactation potential with low complication rates.

Can It Be Safe and Aesthetic? An Eight-year Retrospective Review of Mastopexy with Concurrent Breast Augmentation.

The safety of concurrently performing mastopexy and breast augmentation is controversial, due to the risk of breast tissue and nipple neurovascular compromise and overall potential high complications rates. This article describes a concurrent procedure of augmentation with implants and a "Tailor-Tack" mastopexy that consistently achieves an aesthetically pleasing breast with acceptable complication rates. This is a retrospective chart review of all consecutive breast augmentations performed concurrently with mastopexy using the "Tailor-Tack" technique by the 2 senior authors (M.M. and O.T.) over an 8-year period. Independent variables were patient demographics, surgical approach, implant type, shape, size, duration of follow-up, and complications. Complications were categorized as "early" (ie, first 30 days) or "late" (ie, after 30 days). Potential early complications include hematoma, skin necrosis, infection, and nipple loss. Potential late complications include recurrent breast ptosis, poor shape of the nipple areolar complex, hypertrophic scarring, implant rupture, capsular contracture, decreased nipple sensation, implant extrusion, reoperation, and scar revisions. The key principle of the technique is to place the breast implant in the dual plane first, and then perform the tailor tacking of the skin for the mastopexy second. Fifty-six consecutive patients underwent augmentation and mastopexy over 8 years with this technique. The average age of the studied patients was 41.2 years. The average follow-up time period was 2.1 years (±8.9 months). Fifty-four patients (96.4%) had implants placed through the periareolar approach, 2 patients (3.6%) had implants placed via the inframammary approach. All implants were placed in a dual plane. Fifty-two patients (92.9%) received silicone implants and 4 patients (7.1%) received saline implants. Patient preference determined implant choice. All but 5 patients had textured implants. Average implant size was 277 cm3 (range 120-800 cm3). Ten patients had complications (17.9%). Complications included hypertrophic scarring in 5 (8.9%) patients; poor nipple-areola complex shape in 4 patients (7.1%); implant ruptures in 3 patients (5.4%); capsular contracture in 3 patients (5.4%); and recurrent ptosis in 2 patients (3.6%). There were no reported early complications such as nipple loss, breast skin necrosis, decreased nipple sensation, implant infections, or extrusions. However, 6 patients (10.7%) required return trips to the operating room for revisions, and 1 patient (1.8%) had a nipple areolar complex scar revised in the office, yielding a 12.5% surgical revision rate for the late complications. It is safe to concurrently perform mastopexy and breast augmentation. In our 8-year review, there were no early catastrophic complications such as skin loss, nipple loss, implant extrusion, or infection. The complications that occurred were the same complications known to occur with the independent performance of mastopexy alone or breast augmentation alone, and they occurred at rates comparable to or less than the national averages for those procedures when they are performed independently. The paramount principle for the success of this technique is to first adjust breast volume and then perform an intraoperatively determined skin resection to fit the new breast volume.