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American Association of Plastic Surgeons

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Crowdsourcing The Ideal Nipple Areolar Complex (NAC) Position For Chest Masculinization Surgery
Wess Cohen, M.D., Rose Maisner, B.S., Nemesis Hazim, B.A., Haripriya Ayyala, M.D., Jonathan Keith, M.D., F.A.C.S..
Rutgers-New Jersey Medical School, Newark, NJ, USA.

PURPOSE: Chest masculinization surgery improves transgender men's physical and mental health. Current recommendations for the nipple areolar complex (NAC) location utilize various anatomic landmarks and obscure ratios. Our purpose is to determine the most aesthetically favorable male NAC position for use in chest masculinization through crowdsourcing.
METHODS: Using Adobe Photoshop CC 2017, we modified NAC position in images of the anterior male chest wall with anatomic ratios preserved. We created 8 NAC locations based on literature recommendations. A survey was distributed online through Amazon Mechanical Turk, requesting demographic data and the top three and least favorite images.
RESULTS: 819 respondents participated in the survey. The most preferred NAC positions were from Image C (score = 1223), A (score = 1020), and D (score = 720). The least preferred position was from Image H (score = 125), G (score = 155), and F (score = 373).
CONCLUSION: Most respondents preferred an internipple distance of 21-22 cm and vertical placement relatively low but within the pectoral border. Despite utilizing different anatomic landmarks, NAC localization was similar for all favored images, suggesting that surgeons may choose parameters based on own preferences, professional opinions, and patient body habitus and proportions, with similar aesthetic outcomes.


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