Current Perceptions of the Aesthetically Ideal Position and Size of the Male Nipple-Areola Complex

Abstract

Background The dimensions of the nipple-areola complex (NAC) and its location on the chest wall are important aesthetic factors in male breast surgery. Objectives This study examines the perceptions of aesthetic surgeons and the general population for the aesthetically ideal position and size of male NAC. Methods An online survey was distributed to the American Society for Aesthetic Plastic Surgery (ASAPS) members and to the general population. Parameters queried included demographics for all participants and academic details for ASAPS members. Both surveys included a male model picture with 16 separate choices for the NAC position from a frontal view, 5 choices for the NAC position from a lateral view, and 6 choices for the NAC dimensions. For all 3 sets of images, the participants were asked to rank the top 3 images they considered most “aesthetically pleasing” in descending order. A weighted scoring rule was created to quantitatively evaluate image choices. Standard statistical methods were employed for analysis. Results The survey was completed by 272 ASAPS members and 4909 participants from the general population. The top 3 choices for NAC location on frontal view were the same for ASAPS members and the general population. The most popular NAC location on lateral view was the same for both groups, but the preferred locations differed between the 2 groups for the second and third choices. The most popular dimensions of the NAC were 2 cm (vertical) × 3 cm (horizontal) followed by 2 cm × 2 cm for both groups. Comparison of the 3 top image choices scores between different ethnic groups and individuals with different gender or sexual orientation demonstrated similar trends. Conclusions This survey identified the preferred position and dimensions of the NAC on the male breast for plastic surgeons and the general population. These parameters should be considered when counseling males undergoing breast surgery.

Commentary on: Analysis of Nipple-Areola Complex Localization Using Male Cadavers: Considerations for Gender-Affirming Surgery

“…For example, the anterior axillary line and medial border of the pectoralis major muscle (PMM) may be less reliable. The authors’ findings corroborate previous studies, 3 , 4 that the most natural shape for a male NAC is horizontal oval, with placement falling somewhere between the fourth and fifth intercostal space. There was no correlation found between age, weight, height or BMI, and the intercostal space the NAC was located.…”

The ideal location of the male nipple-areolar complex: A pinpointing algorithm

“…Lastly, mainly Caucasian men participated in this study. As addressed by Maas et al., this could be a limitation to the general applicability to populations with more divergent ethnic groups (Kaoutzanis et al., 2020 ; Kasai et al., 2015 ). Further research should be undertaken with more focus on ethnicity.…”

Double Incision Mastectomy with Free Nipple Graft for Masculinizing Chest Wall Surgery

“…The nipple–areolar complex grafts are marked as 3 cm by 2 cm transversely oriented ovals along the long axis of the nipple in an axial plane. 10 They are harvested as full thickness grafts.…”