Developing Practice Guidelines on Chest Masculinization: Designing Male Neo-nipple-Areolar Complex

Area of Science:

• Plastic Surgery
• Anatomy
• Gender Affirming Care

Background:

• Nipple-areolar complex (NAC) reconstruction is vital for patient satisfaction in chest masculinization surgery.
• Limited data exists on ideal male NAC design, especially regarding dynamic dimensional changes.

Purpose of the Study:

• To analyze male NAC characteristics and dimensional variability.
• To inform guidelines for designing the neo-NAC in transgender patients.

Main Methods:

• Measurements of NAC height, width, sternal notch-to-nipple distance, and internipple distance (IND) were taken in 30 cisgender males.
• Measurements were recorded in both standing and supine positions to assess positional changes.
• Additional variables like BMI, weight, height, age, and ethnicity were documented.

Main Results:

• NAC height and width showed minor variations between supine and standing positions.
• Sternal notch-to-nipple distance and IND decreased significantly when standing, indicating medialization.
• The NAC height-to-width ratio also decreased in the upright position.

Conclusions:

• Upright positioning may lead to a more medial and elliptical neo-NAC in chest masculinization.
• Surgeons must consider intraoperative positional changes in neo-NAC dimensions.
• Final neo-NAC placement should be determined with the patient in an upright sitting position.