Knox Aaron D C, Ho Adelyn L, Leung Leslie, Hynes Sally, Tashakkor A Yashar, Park Yoon Soo, Macadam Sheina A, Bowman Cameron C
Vancouver, British Columbia, Canada; and Chicago, Ill.
From the Division of Plastic Surgery and the Department of Internal Medicine, Faculty of Medicine, University of British Columbia; Vancouver General Hospital; and the Department of Medical Education, University of Illinois at Chicago.
Plast Reconstr Surg. 2017 Jun;139(6):1260e-1272e. doi: 10.1097/PRS.0000000000003388.
Many techniques exist for subcutaneous mastectomy in female-to-male transgender patients. The authors review outcomes for two techniques and present an algorithm to aid surgeons in technique selection.
One hundred one consecutive female-to-male transgender patients undergoing subcutaneous mastectomy using the concentric circular or free nipple graft technique were retrospectively reviewed. An algorithm for procedure selection was created using classification and regression tree analysis. Aesthetic results (nipple-areola complex, scar, and chest contour) were also independently reviewed.
Two hundred two subcutaneous mastectomies were performed (concentric circular, 92 breasts; free nipple graft, 110 breasts). The overall complication rate was 21.3 percent, with 6.4 percent requiring operative intervention (free nipple graft, 1 percent; concentric circular, 13 percent; p < 0.001). The overall revision rate was 23.8 percent (free nipple graft, 12.7 percent; concentric circular, 37.0 percent; p < 0.001). In the concentric circular group, there were 3.3 times the odds of total complications (p = 0.03) and 4.0 times the odds of revision surgery (p < 0.001). Mean aesthetic scores for the concentric circular technique were superior to free nipple graft for scar (3.39 versus 2.62; p < 0.001) and contour (3.82 versus 3.34; p < 0.001).
In patients who meet selection criteria, the concentric circular technique is preferred because of fewer scars, improved aesthetic contour, and potential for retained nipple sensation. These patients must be counseled regarding the higher rate of complications and revisions. It was determined that smokers and those with a nipple-to-inframammary fold distance greater than 7 cm or nipple-to-inframammary fold distance less than 7 cm and a body mass index greater than 27 kg/m should undergo the free nipple graft technique because of the increased risk of complications with the concentric circular technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在女性向男性转变的变性患者中，存在多种皮下乳房切除术技术。作者回顾了两种技术的结果，并提出一种算法以帮助外科医生选择技术。
回顾性分析了连续101例行皮下乳房切除术的女性向男性转变的变性患者，这些患者采用了同心圆技术或游离乳头移植技术。使用分类和回归树分析创建了手术选择算法。还对美学结果（乳头乳晕复合体、瘢痕和胸部轮廓）进行了独立评估。
共进行了202例皮下乳房切除术（同心圆技术92例乳房；游离乳头移植技术110例乳房）。总体并发症发生率为21.3%，其中6.4%需要手术干预（游离乳头移植技术1%；同心圆技术13%；p<0.001）。总体修复率为23.8%（游离乳头移植技术12.7%；同心圆技术37.0%；p<0.001）。在同心圆技术组中，发生总体并发症的几率是游离乳头移植技术组的3.3倍（p=0.03），修复手术的几率是游离乳头移植技术组的4.0倍（p<0.001）。同心圆技术的平均美学评分在瘢痕方面优于游离乳头移植技术（3.39对2.62；p<0.001），在轮廓方面也优于游离乳头移植技术（3.82对3.34；p<0.001）。
在符合选择标准的患者中，同心圆技术更受青睐，因为瘢痕更少、美学轮廓更佳且有可能保留乳头感觉。必须向这些患者告知并发症和修复率较高的情况。已确定，吸烟者以及乳头至乳房下皱襞距离大于7 cm或乳头至乳房下皱襞距离小于7 cm且体重指数大于27 kg/m²的患者应采用游离乳头移植技术，因为同心圆技术并发症风险增加。
临床问题/证据级别：治疗性，III级。
