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The Mango Method: A Novel Technique to Improve Aesthetic Outcomes of Free Nipple Grafting in Masculinizing Top Surgery
Neel D Bhagat BS1, Keeley Newsom BS1, Nikhi P. Singh MD, MBA2, Lauren Lautenslager MD2, Ivan Hadad MD2
1 Indiana University School of Medicine, Indianapolis, IN
2 Division of Plastic Surgery, Department of Surgery ,Indianapolis, IN
Indiana University School of Medicine
2023-01-29
Presenter: Neel D Bhagat
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. All work on this project represents the original work of the students, residents, and faculty involved with the project."
Director Name: William Wooden
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
Masculinizing top surgery (MTS) can help align a patient's chest appearance with their gender identity. It's commonly performed using a bilateral inferior mammary fold incision with free nipple grafting (FNG). Nipple areolar complex (NAC) reconstruction is a critical component however there is a lack of information surrounding the technique of NAC reconstruction. We review patients undergoing MTS with FNG using a novel technique of FNG, known as the "Mango Method".
Methods
This retrospective study included patients 18 or older, who underwent MTS with FNG between 2020-2022. Those who underwent MTS without FNG were excluded. A single surgeon performed all operations.
Results
Of the 166 patients, 31.3% were smokers. Most patients (97.6%) did not experience partial or total graft lost. 2 patients experienced partial unilateral nipple necrosis and 2 experienced total unilateral graft loss. 8.4% of patients incurred a complication with the most common being seroma, which occurred in 7 patients (4.2%). Interestingly, patients undergoing combo cases with OBGYN for hysterectomy followed by MTS were more likely to incur a complication than those who underwent only MTS (p=0.012).
Conclusions
The Mango Method is a safe, effective method to optimize NAC appearance for FNG in MTS. The procedure is straightforward, does not require harvest or creation of a composite graft, and does not require excessive preparation of the de-epithelialized site for graft inset. This reduces operative time and complexity in comparison to some of the current modifications of NAC reconstruction. Additionally, patients appear to be satisfied with their outcomes following reconstruction.
