Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, Yamanashi University Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3863, Japan.
Aesthetic Plast Surg. 2019 Oct;43(5):1195-1203. doi: 10.1007/s00266-019-01409-2. Epub 2019 May 29.
Mastectomy is performed in female-to-male transsexual (FTM TS) patients as a surgical treatment to make a female thorax resemble a male thorax; however, no studies have examined the nipple-areolar complex (NAC) position in FTM TS patients after mastectomy.
The NAC position in 41 FTM TS patients before and after non-skin-excisional mastectomy was examined and compared with that in 50 age- and BMI-matched biologically male subjects as controls. The factors affecting the NAC position after the operation were also examined and verified by multiple regression analysis.
After non-skin-excisional mastectomy, the NAC in the FTM TS patients was positioned significantly more medially (horizontal NAC position ratio {('internipple distance'/'width of thorax') × 100} [HNPR]: preoperatively, 70.07% ± 4.19%; postoperatively, 63.28% ± 3.79%) and cranially (vertical NAC position ratio {('distance from sternal notch to nipple height'/'distance from sternal notch to umbilicus') × 100} [VNPR]: preoperatively, 43.87% ± 3.68%; postoperatively, 41.37% ± 3.15%). Postoperatively, the NAC in the FTM TS patients was located significantly more medially than that in the control subjects (HNPR: 63.28% ± 3.79% to 66.79% ± 4.82%), although the height of the NAC was the same. Multiple regression analysis revealed that the NAC position on breasts characterized by ptosis, a high projection, and lateral leaning (low skin elasticity and a substantial amount of skin between the nipples) tended to be positioned more medially after non-skin-excisional mastectomy. Laterally deviated eccentric circular type mastectomy may be a good option for FTM TS patients who have moderately sized breasts with such features.
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乳房切除术是女性变男性（FTM TS）患者的一种手术治疗方法，旨在使女性胸部类似于男性胸部；然而，目前尚无研究探讨乳房切除术对 FTM TS 患者乳头乳晕复合体（NAC）位置的影响。
研究共纳入 41 例 FTM TS 患者，在接受非皮肤切除乳房切除术前后，对 NAC 位置进行了检查，并与 50 名年龄和 BMI 匹配的男性生物学对象作为对照组进行了比较。还通过多元回归分析，对术后影响 NAC 位置的因素进行了检查和验证。
非皮肤切除乳房切除术后，FTM TS 患者的 NAC 位置明显更偏向内侧（水平 NAC 位置比 {（“乳头间距离”/“胸廓宽度”）×100} [HNPR]：术前 70.07%±4.19%；术后 63.28%±3.79%）和头侧（垂直 NAC 位置比 {（“胸骨切迹至乳头高度的距离”/“胸骨切迹至脐部的距离”）×100} [VNPR]：术前 43.87%±3.68%；术后 41.37%±3.15%）。术后，FTM TS 患者的 NAC 位置明显偏向内侧，而对照组的 NAC 位置则偏向外侧（HNPR：63.28%±3.79%至 66.79%±4.82%），尽管 NAC 的高度相同。多元回归分析显示，具有下垂、高突、侧倾（乳头间皮肤弹性差且皮肤量多）特征的乳房，在接受非皮肤切除乳房切除术后面部 NAC 位置更偏向内侧。对于乳房大小适中、具有上述特征的 FTM TS 患者，采用外侧偏心圆型乳房切除术可能是一种较好的选择。
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