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Preservation Of Sensation After Gender-affirming Mastectomy: A Multi-institutional, Prospective Case Control Study Of Quantitative And Qualitative Sensory Outcomes
Katya Remy, MD1, Chase Alston, MHS
2, Leslie E. Cohen, MD
2, Katherine H. Carruthers, MD
1, Eleanor G. Tomczyk, MD
1, Jonathan M. Winograd, MD
1, William G. Austen, Jr., MD
1, Ian L. Valerio, MA
1, Lisa Gfrerer, MD
2;
1Massachusetts General Hospital, Boston, MA, USA,
2Weill Cornell Medicine, New York, NY, USA
PURPOSE:To analyze
the quantitative and qualitative sensory outcomes of gender-affirming mastectomy (GAM) with targeted nipple areola complex (NAC) reinnervation (TNR).
METHODS:25 subjects (GAM with TNR) were compared to 25 matched controls (GAM without TNR) and 25 cis-males (no GAM). Monofilament and patient-reported outcomes were completed preoperatively and postoperatively at 1, 3, 6, 9 and 12 months. Pressure, 2-point discrimination, vibration, pinprick, and temperature sensation were tested preoperatively and postoperatively at 12 months.
RESULTS:NAC and chest monofilament values in subjects were significantly better than in controls and comparable to preoperative values starting 3 months and 1 month postoperatively, respectively. At 12 months, all sensory variables were significantly better than controls and comparable or better than preoperative values but remained significantly worse than cis-males(Table 1). Starting 3 months postoperatively, subjects reported significantly better nipple, erogenous, and chest temperature sensation, but similar chest light touch and pressure as compared to controls. Subjects reported significantly less chest pain and phantom sensation up to 9 months compared to controls, but higher nipple hypersensitivity up to 3 months.
CONCLUSION:TNR led to restoration of sensation to preoperative values by 12 months with less pain and phantom sensation but with transient nipple hypersensitivity.
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