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Impact Of Nipple Areolar Complex Reinnervation On Sensory Outcomes And Patient Satisfaction Data Following Gender-affirming Mastectomy
Kassandra Carrion, BA, Allison Hu, MD, Athena Le, BS, Nathan S. Makarewicz, BA, Dung Nguyen, MD, PharmD, FACS;
Stanford University, Palo Alto, CA, USA
Purpose- Loss of sensation to the nipple areola complex (NAC) can cause pain, hypoesthesia, and have adverse psychosocial consequences for gender dysphoria patients who undergo masculinization surgery.
Methods- A retrospective chart review was conducted on 63 patients who underwent gender-affirming mastectomy, and 10 patients who underwent non-gender affirming mastectomy at our institution between 8/10/16 and 7/7/23. A survey was sent to transitioning patients post-operatively. Semmes-Weinstein monofilament testing was used to measure sensation at the nipple, areola, and breast in superior, medial, lateral, inferior quadrants.
Results- Average age at surgery was 22±9.5 years. The average number of grafted nerves for the treated group was 2.7±1.35. Semmes-Weinstein monofilament testing showed a statistically significant recovery in fine sensation all segments of patients undergoing NAC reinnervation compared to those who were not reinnervated (Table 1). Treated patients rated NAC sensitivity as the same compared with before the operation, NAC reaction was weaker to the touch, and all patients said they would choose the same operation again. Average pain score at rest was 1.24±0.52 and 1.29±0.62 during normal activities. Post-operative overall health was significantly higher(p<0.01).
Conclusions- This is the largest study analyzing sensory outcomes following nipple neurotization in gender-affirming mastectomy, and confirms sensory improvement in the nipple, areola and breast. Patient satisfaction data suggests that reinnervation can be protective against neuropathic pain and improves quality of life.
Table 1 | | | | | | | |
| Control | Reinnervation | |
| Preop sensation | Postop sensation | α | Preop sensation | Postop sensation | α | p* |
| Inferior Areola | 2.91(0.24) | 4.96(0.94) | -9.43 | 3.01(0.47) | 3.75(1.19) | -6.48 | p<0.001 |
| Lateral Areola | 2.94(0.37) | 4.87(0.83) | -9.45 | 3.06(0.47) | 3.73(1.15) | -5.86 | p<0.001 |
| Medial Areola | 2.83(9x10-16) | 5.41(1.16) | -9.92 | 3.12(0.52) | 3.81(1.13) | -6.18 | p<0.001 |
| Superior Areola | 2.83(9x10-16) | 5.71(1.09) | -11.87 | 3.10(0.52) | 3.76(1.13) | -5.93 | p<0.001 |
| Inferior Breast | 2.83(9x10-16) | 4.44(0.93) | -7.78 | 3(0.43) | 3.37(0.94) | -3.92 | p<0.001 |
| Lateral breast | 2.87(0.17) | 4.90(0.97) | -9.22 | 3(0.41) | 3.30(0.88) | -3.42 | p<0.001 |
| Medial Breast | 2.83(9x10-16) | 4.83(1.02) | -8.8 | 3.01(0.45) | 3.38(0.86) | -4.15 | p<0.001 |
| Superior Breast | 2.83(9x10-16) | 4.68(1.14) | -7.25 | 2.95(0.4) | 3.26(0.84) | -3.51 | p<0.001 |
| Nipple | 2.83(9x10-16) | 5.35(1.07) | -10.49 | 3.11(0.48) | 3.77(1.15) | -5.89 | p<0.001 |
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