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. 2021 Mar 15;9(3):e3459.
doi: 10.1097/GOX.0000000000003459. eCollection 2021 Mar.

Chest Masculinization Technique and Outcomes in 72 Double-incision Chest-contouring Procedures with Free Nipple Grafting

Alexandra I Naides  1 , Jerette J Schultz  1 , Nikita O Shulzhenko  1 , Jonathan D Keith  1   2
Affiliations

Chest Masculinization Technique and Outcomes in 72 Double-incision Chest-contouring Procedures with Free Nipple Grafting

Alexandra I Naides et al. Plast Reconstr Surg Glob Open. .

Abstract

Chest masculinization for gender affirmation is the removal of breast tissue and excess skin, often with repositioning of the nipple areola complexes to achieve a male-appearing chest. A double-incision technique with free nipple grafting (FNG) is the preferred method for trans men with large, ptotic breasts. The authors present the outcomes of 72 consecutive chest masculinization cases using this technique.

Methods: A retrospective chart review was performed between 2015 and 2020 on all patients who underwent chest masculinization surgery for gender dysphoria by the senior author (JDK). Patients who underwent masculinization by concentric circle or liposuction-only techniques were excluded. Potential risk factors for complications were analyzed with Chi-square and logistic regression techniques. P < 0.05 was considered significant.

Results: Seventy-two patients underwent bilateral mastectomy with free nipple grafting. There were 6 major complications resulting in return to operating room, re-admission, or need for interventional procedure. These included 4 hematomas, 1 infection, and 1 hospital admission for shortness of breath and pain.Minor complications treated conservatively included 3 seromas, 1 instance of delayed wound healing, 1 case of superficial thrombophlebitis, and 4 hypertrophic scars. Eleven patients experienced nipple areolar complex complications. Four patients underwent revision surgery. Nicotine use was associated with a higher rate of hematoma (χ2: 9.95, P = 0.007). Later operative date, a surrogate for experience, was associated with decreased return to the operating room (Odds ratio: 0.99, P = 0.025).

Conclusion: Double-incision chest contouring with free nipple grafting provides good chest contour for transgender men,with low complication rates.

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Conflict of interest statement

Disclosure: The authors have no financial interests to declare in relation to the content of this article. There are no conflicts of interest to report.

Figures

Fig. 1.
Fig. 1.
Preoperative markings.
Fig. 2.
Fig. 2.
Elevation of superior flap up to clavicle.
Fig. 3.
Fig. 3.
En bloc tissue removal.
Figure 4.
Figure 4.
Pre- and postoperative photographs. A, Preoperative photograph of patient with grade I ptosis. B, Postoperative result.
Figure 5.
Figure 5.
Pre- and postoperative photographs. A, Preoperative photograph of patient with grade III ptosis. B, Postoperative result.
See this image and copyright information in PMC

References

    1. van de Grift TC, Kreukels BP, Elfering L, et al. Body image in transmen: multidimensional measurement and the effects of mastectomy. J Sex Med. 2016; 13:1778–1789 - PubMed
    1. Poudrier G, Nolan IT, Cook TE, et al. Assessing quality of life and patient-reported satisfaction with masculinizing top surgery: a mixed-methods descriptive survey study. Plast Reconstr Surg. 2019; 143:272–279 - PubMed
    1. Ammari T, Sluiter EC, Gast K, et al. Female-to-male gender-affirming chest reconstruction surgery. Aesthet Surg J. 2019; 39:150–163 - PubMed
    1. Monstrey S, Selvaggi G, Ceulemans P, et al. Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg. 2008; 121:849–859 - PubMed
    1. Safa B, Lin WC, Salim AM, et al. Current concepts in feminizing gender surgery. Plast Reconstr Surg. 2019; 143:1081e–1091e - PubMed

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