The Nipple Split Sharing vs. Conventional Nipple Graft Technique in Chest Wall Masculinization Surgery: Can We Improve P
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ORIGINAL ARTICLE
BREAST SURGERY
The Nipple Split Sharing vs. Conventional Nipple Graft Technique in Chest Wall Masculinization Surgery: Can We Improve Patient Satisfaction and Aesthetic Outcomes? Samyd S. Bustos1 • Antonio J. Forte2 • Pedro Ciudad3 • Oscar J. Manrique1
Received: 18 April 2020 / Accepted: 23 May 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Abstract Background Double incision mastectomy with free nipple grafts (DIFNG) offers more flexible nipple–areola complex (NAC) resizing and repositioning in transmale and gender non-conforming individuals. The cis-male NAC has a smaller diameter, oval shape and lateral position. If nipple grafts are performed without having these considerations, aesthetics can be dissatisfying. We aim to describe the nipple split sharing technique during chest wall masculinization surgery comparing surgical, patient-reported outcomes (PRO) and aesthetic results with the conventional technique. Methods This was a retrospective review of transmale patients who underwent DIFNG from January 2017 to January 2019. The cohort was divided into two groups: conventional and the splitting technique. Demographics, intraoperative and postoperative outcomes were recorded. In addition, PRO using Body-Q scale and aesthetic results using a Likert-based scale were analyzed.
This paper was presented at the United States Professional Association for Transgender Health (USPATH) Scientific Symposium, at Washington, D.C., in September 2019, and at the Northeastern Society of Plastic Surgeons (NESPS) Annual Meeting, at Pittsburgh, PA, in October 2019. & Oscar J. Manrique [email protected] 1
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
2
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL, USA
3
Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
Results Thirty-four patients (68 breasts) underwent DIFNG. A total of 32 breasts underwent the split nipple reconstruction approach, whereas 36 underwent conventional technique. Median patient age and BMI in the nipple sharing and conventional technique groups were 27 years and 35.4 kg/m2, and 24 years and 32.2 kg/m2, respectively. Differences on postoperative complications were not statistically significant. Patient satisfaction on nipples’ module was 90.7% vs. 58.1% in the nipple sharing vs. conventional technique, respectively (p \ 0.05). The nipple’s masculine aspect, size, contour, position and scars were aesthetically superior to the split approach (p \ 0.05). Conclusion Double incision mastectomy with nipple split sharing technique has good aesthetic outcomes, a low complication rate and high patient satisfaction. It is a great surgical alternative to improve aesthetics in chest wall masculinization surgery. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evide
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