Immediate targeted nipple areolar complex reinnervation: Improving outcomes in gender-Affirming mastectomy

Abstract

Background: Female-To-male mastectomy often renders the chest skin and nipple areolar complex (NAC) insensate. We propose a new technique of preserving the intercostal nerves and using them to reinnervate the NAC after mastectomy. Methods: We performed a prospective analysis of transmasculine patients who underwent female-To-male mastectomy. The technique involves dissecting out the lateral intercostal nerves to length and performing a neurorrhaphy to nerve stumps at the base of the NAC. Sensory outcomes, as assessed with Semmes Weinstein monofilaments, were compared to a cohort of patients who underwent mastectomy without neurotization. Results: Ten patients with a mean age of 17.5 years (range: 16 19 years) underwent mastectomy. The final follow-up was a mean of 15.4 4.3 months for the treated group and 40.7 12.9 months for the control group. Compared to control patients, treated patients had significant improvement in sensation at the nipple (P 0.0002), areola (P = 0.0001), and peripheral breast skin (P = 0.0001). For treated patients, there was no statistically significant difference in sensation between preoperative and postoperative sensation in all tested areas at final follow-up. Conclusion: This proof of concept study suggests that immediate reinnervation of the NAC after mastectomy enhances recovery of NAC sensation in patients undergoing female-To-male mastectomy and may be further generalized to women undergoing postmastectomy breast reconstruction.