Learning Curve for Sensory Preservation after Transgender Mastectomy Using Targeted Nipple Reinnervation with Direct...

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Gender Affirming Care

Background:

• Gender-affirming mastectomy (GAM) often involves nipple-sparing techniques.
• Targeted Nipple-Sparing Mastectomy with reinnervation (TNR) aims to restore sensation.
• Evaluating nerve coaptation techniques is crucial for optimizing outcomes.

Purpose of the Study:

• To assess the learning curve for nerve dissection in TNR during GAM.
• To compare postoperative sensory outcomes between direct nerve coaptation and nerve allograft reconstruction.
• To analyze the efficacy of TNR in restoring nipple-areola complex (NAC) and chest sensation.

Main Methods:

• A comparative study involving 60 patients undergoing GAM.
• Three groups were analyzed: nerve allograft reconstruction (n=20), direct nerve coaptation (n=20), and a control group without TNR (n=20).
• Quantitative Sensory Testing (QST) and patient-reported outcomes were used for assessment.

Main Results:

• Both direct coaptation and allograft groups showed significant improvements in NAC and chest sensation compared to the control group.
• At 12 months, 100% of the direct coaptation group and 67% of the allograft group regained baseline light touch sensation in the NAC.
• High percentages of patients in both TNR groups reported significant light touch and erogenous sensation.

Conclusions:

• TNR is effective in restoring sensation to the NAC and chest following GAM.
• Direct nerve coaptation and nerve allograft reconstruction are both feasible and yield comparable long-term sensory results.
• TNR techniques, including direct repair, are vital for improving patient satisfaction and quality of life after GAM.