The Lahey Modification for Masculinizing Top Surgery: A Safe and Effective Technique to Preserve a Sensate Nipple

Masculinizing top surgery is the most prevalent gender-affirming procedure offered to transgender and gender diverse individuals, most commonly via gender-affirming mastectomy and free nipple grafting. Our institution presents a novel technique for gender-affirming top surgery, adapted from the modified Robertson technique for reduction mammoplasty. Our approach preserves a sensate and dynamic nipple using an inferiorly-based, bell curve pedicle.

A retrospective chart review was conducted including all patients who underwent the Lahey modification technique for gender-affirming top surgery by a single surgeon at an academic hospital in Massachusetts from October 2018 to November 2024. Patient characteristics, intra-operative data, and clinical outcomes were analyzed utilizing descriptive statistics and univariate logistic regression. Outcomes were stratified by resection weight greater or less than the mean (x̄ = 571.5 g) to inform patient selection.

Thirty-eight patients (72 nipples) were included in this study. The median length of follow-up was 5 months (range 1 week-60 months). In total, there was partial necrosis of seven nipples (9.7%), decreased sensation in seven nipples (9.7%), and complete loss of sensation in one nipple (1.4%). None of the patients experienced complete nipple loss. There was an overall high rate of subjective patient satisfaction.

This study demonstrates that the Lahey modification is a safe technique for gender-affirming top surgery for patients with a wide range of breast sizes and ptosis. Our results exhibit high rates of retained nipple sensation and piloerection, with satisfactory aesthetic outcomes.

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