ISSN: 2639-2127
Authors: Evans AG, Park BC, Saad M, Assi PE and Kassis SA*
Introduction: Gender affirming chest surgeries are a treatment for transgender and gender diverse individuals who suffer from gender dysphoria. Double incision mastectomy with free nipple grafts is the most common technique used for masculinization of the chest for Fischer grade 2B to 4 patients. However, this technique sacrifices the nerves to the nipple-areolar complex (NAC). While multiple nipple pedicles have been described in cisgender reduction mammoplasty, only an inferior pedicled mammaplasty approach has been described for chest wall masculinization for Fischer grade 2B to 4 patients. Case Presentation: We describe the surgical technique of a superomedial pedicle chest masculinization surgery for an individual with Fischer grade 2B breasts. Sensation was preserved at 2-weeks post-surgery. At 4-months, using a 0 to 10 numeric rating scale, patient satisfaction was 9 for the overall cosmetic outcome and a 9 for the masculinization. Using inferior sternum sensation as a reference (10), areola sensation on the superior side adjacent the nipple was a 6.5 on the right and an 8 on the left. Chest sensation was a 10 in the superolateral, inferolateral, and superomedial quadrants bilaterally, and was an 8 in bilateral inferomedial quadrants. 2-point discrimination of the areola was assessed on the inferior side adjacent the nipple and was 13mm on the left and 14mm on the right. Semmes-Weinstein monofilament testing of the areola was performed adjacent to the nipple superiorly (R: 4.31, L: 4.56), inferiorly (R: 4.31, L: 6.65), medially (R: 4.31, L: 6.65), and laterally (R: 4.31, L: 6.65). Conclusion: A mastectomy technique using a superomedial pedicle can preserve the nerve to the nipple-areolar complex to retain sensation while providing sufficient cosmetic outcome.
Keywords: Mastectomy; Reconstructive Surgical; Transsexualism; Surgery; Sex Reassignment Surgery
