American Association of Plastic Surgeons
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Targeted Nerve Regeneration Of The Nipple Areolar Complex In Chest Masculinization
Alexandra Naides1, John Cece, MD1, Jonathan Keith, MD2.
1Rutgers New Jersey Medical School, Wayne, NJ, USA, 2RWJ/Barnabas Health Care System, Livingston, NJ, USA.

PURPOSE: This article describes a novel technique for targeted nerve regeneration of the nipple areolar complex after chest masculinization. This method employs coaptation of an intercostal nerve with reliable location and minimal donor site morbidity.
METHODS: Bilateral, double-incision chest masculinization with free nipple grafts were performed in 24 patients. An intercostal nerve was identified at the lateral border of the pectoralis muscle. Coaptations were performed with 8-0 nylon suture to an Axogen 1-2mmX70mm graft. A conduit and fibrin sealant was applied (Fig 1). The end of the graft was brought through a dermal window in the NAC and secured without tension. The incisions were closed in standard fashion.
RESULTS: 48 double incision chest masculinization surgeries with free nipple grafts and nerve coaptations were performed in 24 patients. There were no instances of extrusion of graft, nipple loss, or neuroma formation. Average additional surgical time was 30 minutes. All patients reported sensation to light touch in NAC after 3 months.
CONCLUSION: Currently described technique to restore nipple sensation in chest masculinization involves direct neurorrhaphy of a lateral intercostal nerve to nerve endings in the NAC. This requires extensive dissection of the intercostal nerve to achieve adequate length for transposition. Use of nerve graft obviates the need for this dissection. Our report outlines our surgical technique and provides preliminary data to support its safety.


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