Background : The number of gender-affirming masculinizing mastectomies performed by plastic surgeons has increased dramatically in recent years. However, few residency programs in the United States have included these procedures as a significant component of resident education. Additionally, achieving symmetry and a masculine chest profile proportional to the patient’s body habitus can be very challenging, particularly in patients who bind their chest and have excess skin of poor quality. We present a fast, reproducible, and easy-to-learn technique for performing inframammary mastectomy with free nipple grafting and our experience at an academic hospital.
Methods : We describe our surgical markings and technique for masculinizing inframammary mastectomy with free nipple grafting. Operative data such as length of surgery, estimated blood loss, level and number of residents assisting, and surgical complications were collected for transgender patients undergoing masculinizing mastectomy before and after instituting this new technique. Data before and after instituting the new technique were then compared to identify any significant trends.
Results : After instituting a new technique for masculinizing mastectomy, operative times were significantly reduced regardless of the training level of the resident assisting. Patients with a larger body mass index, which can be particularly challenging, also did not increase operative times after developing our new technique. There was no increase in intra-operative or post-operative complications after instituting our new approach.
Conclusions : We have described a novel technique for performing masculinizing inframammary mastectomy with free nipple grafting that consistently yields symmetric, satisfactory results even in larger patients with poor or excess skin. As more academic institutions establish transgender surgery clinics, reproducible surgical techniques such as the one described will help train the next generation of plastic surgeons to have the expertise to service this rapidly burgeoning field.