A New Male Nipple Areolar Complex Design in Trans Men Chest Masculinization

Abstract

Background. Chest-Wall Contouring is generally the first surgical step Trans Men sex reassignment surgery. In case of medium/big size and ptotic breast, free nipple graft technique is the procedure of choice. The position and aspect of neo-nipples are of paramount importance to resemble a male chest. The aim of the present paper was to develop and apply a simple new method of nipple-areola complex free graft. Methods. From January 2018 to December 2020 a novel nipple areola complex (NAC) grafting technique was developed and used when dealing with breast amputation and NAC graft in patients with nipple projection and dimension > 1 cm. The graft was taken from the pigmented skin from the areola leaving a central 5 mm diameter of thoracic/recipient skin. Results. 15 patients (30 NACs) were treated with the described new NACs graft technique. All patients healed uneventfully and none of them required revision surgery or correction. Discussions. Traditional nipple grafts harvested from the areola are often flat or depressed. Nipple grafts harvested from large and projected female nipples are frequently associated with partial necrosis, graft discoloration and need for revision surgeries or tattoos. In our series, the use of a graft harvested from the pigmented skin of the areola and leaving a central 5 mm diameter of thoracic/recipient skin creates a 3D shadow effect similar to the one of a male nipple. This original and simple procedure can aid surgeons with reproducible nipple reconstructions in free nipple graft mastectomy in case of large nipples.

The Ergonomic FALD Flap for One-stage Total Breast Reconstruction

“…The ergonomic principle behind the vertical orientation and molding the FALD flap this way comes up with a flap that mimics the morphology and the dynamics of natural breast tissue in its vertical and horizontal positions. 30 Specifically, in our described technique, each area of the flap is carefully used to give volume where it is needed, making the most of every single portion and achieving a one-stage total BR. 31 Taminato et al also reported a median skin paddle height of 5 cm (range 4-7), which is unfortunately inadequate to ensure satisfactory volume.…”

Pressure Ulcers Incidence in a Perioperative Neurosurgical Setting

“…Pressure ulcer development is a major burden in surgical patients, increasing the length of hospital stay and the healing process, possibly leading to infectious complications and higher health care costs 1,2 . Despite the continuous release of novel matrices and products stimulating tissue regeneration and despite progress made in the field reconstructive surgery thus far, medical and conventional surgical strategies for loss of substance lesions present limits when it comes to complex tissue defects requiring fine reconstruction and generate large part of pathology associated high morbidities and costs [3][4][5][6][7][8] . Pressure ulcers are recognized as an unfavorable prognostic factor that is associated with increasing morbidity and mortality [9][10][11] .…”