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

Successful nipple-areolar complex (NAC) reconstruction greatly influences patient outcomes for transgender patients undergoing chest masculinization. Despite the recent rise in case volume, little is known on designing the ideal NAC that maintains its aesthetics in dynamic settings. This study aimed to examine the characteristics of male NACs and their dimensional variability to help develop guidelines on designing the neo-NAC.

Thirty cisgender male participants were enrolled. NAC height and width, sternal notch-to-nipple distance, and internipple distance (IND) were measured in standing and supine positions with stable room temperature to prevent measurement bias. Other variables recorded included chest circumference, NAC angulation, body mass index, weight, height, age, and ethnicity.

Mean standing and supine measurements were as follows: NAC height, 21.2 mm (SD, 3.9) versus 23.4 mm (SD, 4.7); NAC width, 29.0 mm (SD, 5.1) versus 29.7 mm (SD, 5.6); sternal notch-to-nipple distance, 20.8 cm (SD, 2.1) versus 19.3 cm (SD, 1.8); and IND, 22.4 cm (SD, 2.3) versus 23.5 cm (SD, 2.5). NAC height-to-width ratio decreases from supine to standing, as well as IND, indicating a medialization of the NACs when upright.

Our findings suggest that during chest masculinization surgery, the design of the male neo-NAC has a risk of being positioned too medial and elliptical with upright positioning. Care must be taken intraoperatively to account for changes in neo-NAC dimensions that occur with body position changes. We strongly recommend that surgeons determine the final position of the neo-NAC intraoperatively while having the patient in upright sitting position.