Patient-reported Outcomes On Subjective Nipple Sensation Following Double-incision And Periareolar Mastectomy For Chest Masculinization
Amy Chen, BS, Shannon R. Garvey, MS, Adam M. Tobias, MD, Ryan P. Cauley, MD, MPH, Bernard Lee, MD, MBA, MPH, FACS.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Purpose:Few studies have examined patient-reported subjective nipple sensation following chest masculinization surgery. We evaluated patient-reported outcomes (PROs) to assess patient and procedural factors associated with post-chest masculinization subjective nipple sensation.Methods:Patients who underwent double-incision or periareolar mastectomies for chest masculinization by a single senior surgeon (2015-2019) were included. Postoperative patients were surveyed with BODY-Q PRO measure (Q-Portfolio.org). Demographic, operative, and postoperative variables were recorded. Patients were stratified by nipple sensation preservation according to their survey response. Univariate and multivariate analyses were performed.Results:Survey response rate was 42.2%. Of the 151 responders, 138(91.4%) received double-incision mastectomies and 13(8.6%) received periareolar mastectomies. 84.6% periareolar patients and 69.6% double-incision patients reported “completely” or “a little” nipple sensation, and the difference trended towards significance (p=0.0719). Obesity (p=0.0080) and increased mastectomy volume (p=0.0247) were significantly associated with decreased nipple sensation. Nipple satisfaction scores were high across all response groups, but significantly higher for patients reporting improved nipple sensation (p=0.0059). Improved nipple sensation preservation may be associated with increased satisfaction with intimacy (p=0.1475) and the chest (p=0.1361), but does not reach significance. Conclusions:Subjective nipple sensation following chest masculinization is underreported. We found that obesity and greater mastectomy weights are associated with increased risk of decreased nipple sensation, and nipple sensation may be associated with postoperative nipple, chest, and intimacy satisfaction. Operative techniques to optimize nipple sensation preservation may improve this population’s postoperative satisfaction.
| Table 1: Preoperative factors, operative factors, and BODY-Q module scores following chest masculinization surgery, grouped by patient-reported postoperative nipple sensation. | ||||
| Response to “Has your nipple sensation been preserved?” | P-value | |||
| “Completely”n=17 | “A little”n=90 | “Not at all”n=44 | ||
| Preoperative Factors | ||||
| Age mean, SD | 28.41, 9.26 | 27.36, 9.03 | 28.43, 8.52 | 0.7681 |
| Race n (%) | 0.3568 | |||
| White | 13 (76.5%) | 73 (81.1%) | 34 (77.3%) | |
| African American | 3 (17.7%) | 6 (6.7%) | 2 (4.6%) | |
| Other | 1 (5.9%) | 11 (12.2%) | 8 (18.2%) | |
| BMI n (%) | ||||
| Nonobese (<30kg/m2) | 13 (76.5%) | 74 (82.2%) | 25 (56.8%) | 0.0080 |
| Obese (≥30kg/m2) | 4 (23.5%) | 16 (17.8%) | 19 (43.2%) | |
| Gender Identity n (%) | 0.5804 | |||
| Transgender male | 16 (94.1%) | 77 (85.6%) | 35 (79.6%) | |
| Non-binary | 0 | 7 (7.8%) | 6 (13.6%) | |
| Other | 1 (5.9%) | 6 (6.7%) | 3 (6.8%) | |
| Smoking n (%) | 0.8776 | |||
| Never | 14 (82.3%) | 78 (86.7%) | 37 (84.1%) | |
| Former | 2 (11.8%) | 9 (10.0%) | 5 (11.36%) | |
| Current | 1 (5.9%) | 3 (3.3%) | 2 (4.6%) | |
| Prior breast reconstruction/reduction n (%) | 1 (5.9%) | 7 (7.8%) | 1 (2.3%) | 0.4021 |
| Operative Factors | ||||
| Mastectomy technique n (%) | 0.0719 | |||
| Double-Incision | 13 (76.5%) | 83 (92.2%) | 42 (95.5%) | |
| Periareolar | 4 (23.5%) | 7 (7.8%) | 2 (4.6%) | |
| Volume removed1 (g)mean, SD | 472.9, 264.8 | 434.2, 306.9 | 607.6, 404.1 | 0.0247 |
| Postoperative Factors | ||||
| Complications (hematoma, seroma, infection) n (%) | 1 (5.9%) | 9 (10.0%) | 3 (6.8%) | 0.9107 |
| NAC hypopigmentation2 n (%) | 8 (61.5%) | 50 (60.2%) | 24 (57.1%) | 0.9648 |
| NAC Tattooing (if NAC was hypopigmented)2 n (%) | 0.0565 | |||
| Yes | 2 (25.0%) | 1 (2.0%) | 2 (8.3%) | |
| Unknown | 1 (12.5%) | 16 (32.0%) | 11 (45.8%) | |
| No | 5 (62.5%) | 33 (66.0%) | 11 (45.8%) | |
| Patient Reported Outcomes | ||||
| BODY-QTM Satisfaction with Nipples score median, IQR | 100.0, 10.0 | 82.0, 41.0 | 75.0, 44.0 | 0.0059 |
| BODY-QTM Satisfaction with Chest score median, IQR | 100.0, 17.0 | 100.0, 17.0 | 87.0, 24.0 | 0.1361 |
| BODY-QTM Sexual Function score median, IQR | 63.0, 22.0 | 58.0, 32.0 | 51.0, 32.0 | 0.1475 |
| BODY-QTM Psychological Function score median, IQR | 68.0, 35.0 | 65.0, 35.5 | 60.0, 23.5 | 0.2755 |
| 1Calculated as average of volumes of tissue removed from left and right breasts.2Patient count and column percentages based on double-incision mastectomy cohort only.Abbreviations: BMI, body mass index; g, grams; IQR, interquartile range; n, frequency; NAC, nipple areolar complex; SD, standard deviation; %, percentage | ||||
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