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Landmark technique for nipple areolar complex positioning in chest masculinization for transmasculine individuals
Charles Raymer, MD; Isabel Ho, BS; Shannon Wu, BA; Raymond Isakov, MD;
Cleveland Clinic
2022-01-14
Presenter: Isabel Ho
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The abstract reflects the original work of the authors.
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Understanding the ideal location of the male nipple areolar complex is important for aesthetic outcomes in chest masculinization. There is a limited discussion in the literature of placement techniques for chest masculinization in gender affirmation.
Methods
The authors describe a surgical landmark technique to approximate the position of the NAC in transmasculine individuals. Nipple areola complex positioning was determined using two landmarks, the clavicle and the pectoralis major. A depression associated with the trapezoid ligament of the clavicle is palpated about two-thirds of the way from its medial attachment to the manubrium. This location is translated inferiorly to its intersection with the sweep of the inferior border of the pectoralis major muscle. This intersection marks the position of the neo-NAC.
Results
172 gender affirming mastectomies were performed from January 2016 to December 2020. Ages ranged from 16 - 52 years (average 30) and BMIs ranged from 18.4 - 48.0 (average 29.5). Mastectomy techniques included periareolar incisions with pedicled NAC and double incision with free nipple grafts. Postoperative follow-up was a minimum of 3 months. The most common complication was postoperative hematoma (13 cases) requiring reoperation in 11 cases. There were 3 postoperative infections requiring reoperation in 1 case. There were no cases of nipple graft loss.
Conclusion
A surgical landmark technique is used to easily approximate the position of the NAC for chest masculinization in transmasculine individuals. Two easily identifiable landmarks are palpated intraoperatively. This technique is simple and applies to a wide range of BMIs.
