Intraoperative Anatomy and Postoperative Sensation of Targeted Nipple Areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy with Free Nipple Grafting

• DOI: 10.1097/01.gox.0000992264.10187.c0
• Publication Date: 2023-10-25T13:07:00Z
• Authors: Katya Remy; Kathryn Packowski; Liana Kozanno; Jonathan Winograd; Katherine Carruthers; Eleanor Tomczyk; William Gerald Au...; Ian Valerio; Lisa Gfrerer
• Keywords: Reinnervation; Areola; Sensation; Intercostal nerves

BACKGROUND: Gender-affirming mastectomy is the most frequently performed procedure in patients transitioning from a woman to man. However, standard surgical approach, intercostal nerves (INC) are transected which may result loss of sensation. Targeted nipple areola complex (NAC) reinnervation (TNR) gender-affirming double incision with free grafts (FNG) aims improve postoperative The TNR technique involves preservation lateral ICN, and coaptation NAC. A comprehensive understanding relevant ICN anatomy important optimize outcomes. METHODS: 26 consecutive who underwent were prospectively enrolled. Data included demographics, weight, intraoperative branches, axon fascicle counts. Sensation was evaluated using monofilaments preoperatively, postoperatively at one, three, twelve months. RESULTS: 52 mastectomies performed. Per mastectomy, median 2 branches (1-5) used for TNR. learning curve associated nerve branch dissection coaptation. In first third performed, an allograft length 3.5 cm (1.5-4.0) required 100% patients, second 88.2% last 52.9%. Median count one (1-1) 3rd, two (1-7) 4th, (1-6) 5th, (1-8) 6th ICN. Mean density 6163.1 (±1478.5) axons/mm2 4221.1 (±1493.7) 5804.8 (±2365.2) (p=0.08). Patients BMIs ≥30 kg/m2 had significantly worse preoperative sensation NAC (p<0.01) breast skin (p<0.05). Mastectomy weight ≥800g also (p<0.0001) There no associations between number found or counts than values 1 month (p<0.01), comparable 3 months, (p>0.05) better 12 months (p<0.01). Chest (p>0.05), that could directly reach NAC, CONCLUSION: FNG allows restoration within postoperatively. direct versus use allograft. 4th 5th often reached directly. Axon not statistically different.