The Nipple Split Sharing vs. Conventional Nipple Graft Technique in Chest Wall Masculinization Surgery: Can We Improve Patient Satisfaction and Aesthetic Outcomes?

Double incision mastectomy with free nipple grafts (DIFNG) offers more flexible nipple–areola complex (NAC) resizing and repositioning in transmale and gender non-conforming individuals. The cis-male NAC has a smaller diameter, oval shape and lateral position. If nipple grafts are performed without having these considerations, aesthetics can be dissatisfying. We aim to describe the nipple split sharing technique during chest wall masculinization surgery comparing surgical, patient-reported outcomes (PRO) and aesthetic results with the conventional technique. This was a retrospective review of transmale patients who underwent DIFNG from January 2017 to January 2019. The cohort was divided into two groups: conventional and the splitting technique. Demographics, intraoperative and postoperative outcomes were recorded. In addition, PRO using Body-Q scale and aesthetic results using a Likert-based scale were analyzed. Thirty-four patients (68 breasts) underwent DIFNG. A total of 32 breasts underwent the split nipple reconstruction approach, whereas 36 underwent conventional technique. Median patient age and BMI in the nipple sharing and conventional technique groups were 27 years and 35.4 kg/m2, and 24 years and 32.2 kg/m2, respectively. Differences on postoperative complications were not statistically significant. Patient satisfaction on nipples’ module was 90.7% vs. 58.1% in the nipple sharing vs. conventional technique, respectively (p