Abstract: An Algorithm for Creation of the Male Nipple Areolar Complex in the Female to Male Transgender Population (Plastic Surgery The Meeting)

Monday, September 26, 2016: 2:05 PM

Sagar Tushar Mehta, MD , Plastic and Reconstructive Surgery, University of Utah Hospitals and Affiliates, Salt Lake City, UT

Daniel P Donato, MD , Plastic Surgery, University of Utah, Salt Lake City, UT

Norelle Walzer, PA-C , Division of Plastic and Reconstructive Surgery, University of Utah Hospitals and Affliates, Salt Lake City, UT

Erin E Anstadt, Medical student , Division of Plastic and Reconstructive Surgery, University of Utah Hospitals and Affliates, Salt Lake City, UT

Cori Agarwal, MD , Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, UT

Presentation PDF file

Background: Female to male (FTM) chest wall reconstruction is becoming widespread in the North American population, but there is limited literature on creation of the male nipple-areolar complex (NAC) from the female NAC. Studies have been performed to assess the dimensions and positioning of the ideal male nipple (3,4), but there are limited techniques to developing that ideal from a female NAC, which tend to have a larger areola, a more prominent nipple, and a different anatomic location (1,2). We have developed specific techniques and an algorithm to help create the ideal male NAC.

Methods: 125 FTM patients underwent either periareolar or subcutaneous mastectomies with extended subpectoral incisions at the University of Utah. From the patient population, an algorithm was developed assessing the type of female NAC (large or small) and creating an aesthetically appropriate male NAC from the nipple and areolar tissue. We also determined a simple method to determine the ideal position of the NAC using the borders of the pectoralis major muscle.

Results: We found that in the 112 subcutaneous mastectomies with an extended subpectoral incision, free nipple graft was ideal for creation of the male NAC. 32 patients with a large female NAC underwent creation of a composite male nipple by separately harvesting areolar and nipple tissue and creating a neo-nipple areolar complex. 80 patients with a small female NAC underwent harvest of the nipple with a measured cuff of areolar tissue to create the male NAC. In the 13 periareolar mastectomies, reduction of nipple projection was ideal for creation of the male NAC. This consisted of excision of exess nipple volume via a Mercedes incision. Ideal nipple positioning was found to be 1 cm above the inferior border and 1cm medial to the lateral border of the pectoralis major muscle.

Conclusions: At the Unversity of Utah, we have established an algorithm for creation of a male NAC from a female NAC in FTM population, correcting for differences associated with the NAC size and the type of procedure performed. We also describe a simple manner to identify the appropriate nipple position based on anatomic landmarks associated with borders of the pectoralis muscle.

30670 An Algorithm for Creation of the Male Nipple Areolar Complex in the Female to Male Transgender Population