Recent trends in nipple reconstruction - A case series and social media analysis of patient preferences

Patients undergoing mastectomies are often offered nipple reconstruction. Nipple areolar tattooing is also an option chosen by many. The purpose of this study is to highlight trends in nipple reconstruction over time and identify factors that may impact patient decision-making.

A retrospective review of gender affirming mastectomies performed at a single institution was performed. A Pearson Chi-Square test was run on categorical data while an independent sample t-test was run on continuous data. Existing literature and social media were used to supplement our primary findings.

Four hundred and forty-three adult patients who underwent surgery between 2017 and 2023 were included. The proportion of patients who chose to have nipple grafts decreased from 91% in 2019 to 78% in 2022. Statistically significant factors in deciding to forego nipple grafts were patient's gender identity, pronouns, and absence of prior testosterone therapy. Discussions held on Reddit forums demonstrated comparable themes for transgender and breast cancer patients when deciding to preserve their nipples or not during their mastectomies.

We have observed anecdotally and objectively that a higher proportion of patients undergoing mastectomies are opting not to pursue surgical nipple reconstruction. There are likely many individual factors that may be related to this decision, including gender identity, perception of added risk, desire to minimize the number of surgeries, and/or option of undergoing future nipple-areolar tattooing. Social media discussions regarding this topic highlight its relevance for patients undergoing both breast reconstruction and gender affirming surgery.