Modified Nipple Flap with Free Areolar Graft for Component Nipple-Areola Complex Construction: Outcomes with A Novel Technique for Chest Wall Reconstruction in Transgender Men

Background: A primary goal in chest wall reconstruction ('top surgery') for trans men is achieving a symmetrical, aesthetically pleasing position of the reconstructed male NAC. In the context of existing surgical techniques for top surgery, the ability to achieve this goal is limited. Methods: The senior author's technique for component NAC creation in chest wall reconstruction for trans men with a modified skate flap and free areolar graft, in conjunction with double-incision mastectomy, is described. A retrospective analysis of 50 consecutive patients who underwent primary, bilateral chest wall reconstruction with this technique was undertaken for the period of March 2015 to October 2016. Results: Average patient age was 30.64 years, with an average BMI of 28.54 kg/m2. Eighty two percent of the sample received pre-operative testosterone therapy, and average operative time was 2 hours and 59 minutes. Average overall mastectomy specimen weight was 627.80 grams. Average length of hospital stay was 0.96 days. Average follow-up duration was 19.02 months. Complications occurred in 10% (n = 5) of patients, including seroma (4%), cellulitis (2%), hematoma (2%), and suture granuloma (2%). Only 5 patients (10%) underwent postoperative revision to adjust NAC size, projection, or symmetry. Twenty-eight patients (56%) underwent secondary revisions, including scar revisions (56%), liposuction (12%), and fat grafting (2%). Conclusions: The use of a modified nipple flap and free areolar graft in transgender chest wall reconstruction for trans men allows for flexible, component construction of the male NAC, in a safe and effective manner. Financial Disclosures: The authors have no relevant financial relationships to disclose Corresponding Author: Alexes Hazen, M.D., Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 305 E. 33rd St., New York, NY 10016, Phone: (212) 263-8492, Fax: (212) 263-3030, E-mail: Alexes.Hazen@nyumc.org ©2018American Society of Plastic Surgeons

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