Background: A primary
goal in chest wall reconstruction (“top surgery”) for trans men is achieving a
symmetric, aesthetically pleasing position of the reconstructed male
nipple-areola complex. Methods: The senior author’s (A.H.) technique for
component nipple-areola complex creation in chest wall reconstruction for trans
men with a modified skate flap and free areolar graft, in conjunction with
double-incision mastectomy, is described. A retrospective analysis of 50
consecutive patients who underwent primary, bilateral chest wall reconstruction
with this technique was undertaken for the period of March of 2015 to October
of 2016. Results: The average patient age was 30.64 years, and the average body
mass index was 28.54 kg/m2. Eighty-two percent of the sample received
preoperative testosterone therapy, and average operative time was 2 hours 59
minutes. Average overall mastectomy specimen weight was 627.80 g, average
length of hospital stay was 0.96 days, and average follow-up duration was 19.02
months. Complications occurred in five patients (10 percent), including seroma
(4 percent), cellulitis (2 percent), hematoma (2 percent), and suture granuloma
(2 percent). Only five patients (10 percent) underwent postoperative revision
to adjust nipple-areola complex size, projection, or symmetry. Twenty-eight
patients (56 percent) underwent secondary revisions, including scar revisions
(56 percent), liposuction (12 percent), and fat grafting (2 percent).
Conclusion: The use of a modified nipple flap and free areola graft in
transgender chest wall reconstruction for trans men allows for flexible,
component construction of the male nipple-areola complex in a safe and
effective manner. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
