Free nipple grafts are commonly used in conjunction with double incision technique for gender-affirming chest surgery. However, there is a lack of data in the recovery of cutaneous sensation after free nipple grafting. In addition, some patients request for reduction of the size of the nipple areolar complex (NAC) to better fit their flatter chests. There is limited data in the literature on the feasibility of reducing or re-contouring the NAC as a graft. In this study, we described three surgical techniques to reduce the nipple size on a nipple graft. We identified 123 patients who underwent double incision with free nipple graft technique for gender-affirming chest surgery between 1st Oct, 2017 to 31st Dec, 2018. We performed reduction and re-contouring of nipple grafts on 62 patients, utilizing 1 of 3 techniques based on a simple algorithm. Postoperatively, we evaluated objectively the recovery of sensation using the Semmes-Weinstein monofilament testing. There was no nipple necrosis. There were 117 patients who developed sensation to their free nipple grafts postoperatively. Most patients started regaining NAC sensation between 3 to 6 months. Preoperatively, 5 patients did not have any sensation in the NACs, and four of these patients developed postoperative sensation of their new nipple grafts. We demonstrated that reducing or re-contouring the NAC as a graft can be done safely and that most patients may regain some sensation to their NAC postoperatively.
Winnie Tong 1* and Elizabeth Tong2