Dermal nipple-areola complex flap method in female to male gender affirming surgery

Subcutaneous mastectomy plays a major role in female to male (FtM) gender affirming surgery, and obtaining a flattering chest contour remains a challenge to the surgeon. We present an operative method using a dermal nipple-areola complex (NAC) flap, with the aim to create a naturally masculine appearance, while reducing the risk of NAC complications by maintaining sufficient neurovascularisation. This case report describes how the novel approach may potentially be applied as an alternative to the traditionally performed free nipple graft technique in FtM gender confirming surgery. The technique is simple, provides an aesthetically appealing outcome and presumably poses a low risk of NAC complications. Intraoperatively, it allows for good exposure and a uniform removal of breast tissue, as well as repositioning and/or resizing of the NAC where required.

The Dermal Nipple-Areola-Complex Flap Method in Female-to-Male Gender Affirming Surgery

Background:Subcutaneous mastectomy (SCM) plays a major role in female-to-male (FtM) gender affirming surgery, and obtaining a flattering chest contour remains a challenge to the surgeon. We present an operative method using a dermal nipple-areola-complex (NAC) flap with the aim to create a naturally masculine appearance, while reducing the risk of NAC complications by maintaining sufficient neurovascularization.Methods:Through a horizontal incision, a superior thoracic full skin flap was elevated at the dissection plane for mastectomy. The mastectomy was continued inferiorly, creating an inferior flap including the NAC. The surface of the inferior flap was deepithelialized, secluding the NAC, which allowed the inferior dermal flap to be inserted posterior to the superior flap. A circular defect was created in the superior flap, into which the NAC was sutured.Results:The surgery delivered satisfactory results with an aesthetically pleasing masculine appearance and a high level of patient satisfaction. We were able to place the horizontal scars inferiorly along the pectoral muscles, which enabled some camouflage. Additionally, the inferior flap provided a uniform filling effect to the chest, further contributing to the male aesthetic. There were no NAC complications.Conclusion:The dermal NAC flap method could be applied as an excellent alternative to the traditionally performed free nipple graft technique in FtM gender confirming surgery. The method is simple, provides an aesthetically appealing outcome, and poses a low risk of NAC complications. Intraoperatively, it allows for good exposure and a uniform removal of breast tissue, as well as repositioning and/or reduction of the NAC where required.

Effect of gigantomastia on School attendance

Introduction. We have been seeing a number of juvenile/teenage girls presenting to our out patient department with gigantomastia/large breasts. These school going girls had not been attending school due to the large breasts and taunting by school mates as well as scrutiny by the public. Aims and Objectives. To do Reduction Mammoplasty. To do histological investigation. To encourage these teenage girls to go back to school. Materials and Methods. Nine juvenile/teenage girls aged between 11 and 16 years were prospectively enrolled for this study from 2016 to 2020. Eight had reduction mammaplasty and one had sub cutaneous mastectomy with free nipple graft. The specimens were weighed and sent for histology. Results. Nine juvenile/teenage girls were included. The age range was 11- 16 years and the weight range was 27-33 Kg. Loss of school attendance time was 3 months to 2 years. Median weight of excised breast tissue was 2.5(1.2 – 5 kg. Histology. Normal breast = 6, Fibroadenosis = 3. Conclusion. Gigantomastia affected school attendance by as much as two years. Reduction mammoplasty was our treatment of choice. Taunting and lack of fitting clothes affected self-esteem of these patients. The juvenile girls have now returned back to school.