Department of Surgery, University of Southern California, Keck School of Medicine, 1500 San Pablo St, Los Angeles, CA 90033, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
J Plast Reconstr Aesthet Surg. 2023 Aug;83:32-41. doi: 10.1016/j.bjps.2023.04.020. Epub 2023 Apr 17.
There is no consensus on the ideal scar location and inframammary fold (IMF) placement in the gender-affirming double-incision mastectomy technique. Recent advances in imaging technology have facilitated noninvasive investigations into anatomic variability, in many cases, obviating the traditional approach of cadaveric dissection to answer anatomic questions. A better understanding of chest wall sexual dimorphism may allow surgeons who perform gender-affirming procedures to achieve more natural-appearing results. A total of 60 chests were analyzed using either cadaveric dissection (n = 30) or virtual dissection with 3-dimensional (3-D) reconstructions of computed tomography (CT) images (n = 30) using the Vitrea® software. Chest proportions were recorded using each technique, correlating surface anatomy with muscular and bony landmarks. Cadaveric and 3-D radiography chest analysis revealed that natal male chest walls are, on average, wider and longer than natal female chest walls. The pectoralis major muscle dimensions and the location of its insertion were not found to significantly differ between male and female chests. The male nipple-areolar complex (NAC) tended to be narrower in length and width, with a less projecting nipple than the female NAC. Finally, the IMF was found to lie over the interspace between the fifth and sixth rib in both male and female chests. Our findings confirm natal male and female IMF are positioned between the 5th and 6th ribs. This fact affirms the senior author's technique of masculinizing the chest, keeping the masculinized IMF at approximately the same level as the natal female IMF and following the pectoralis major muscle edges to define the resulting scar in a way that differs from previously reported techniques.
在性别肯定双切口乳房切除术技术中，对于理想的疤痕位置和乳晕下皱襞（IMF）放置，目前尚无共识。成像技术的最新进展促进了对解剖变异性的非侵入性研究，在许多情况下，避免了传统的尸体解剖方法来回答解剖问题。更好地了解胸壁的性别二态性可能使进行性别肯定手术的外科医生能够获得更自然的效果。使用 Vitrea®软件，共分析了 60 个胸部，其中 30 个使用尸体解剖（n=30），30 个使用 CT 图像的三维（3-D）重建进行虚拟解剖。使用每种技术记录了胸部比例，将体表解剖与肌肉和骨骼标志相关联。尸体和 3-D 射线照相胸部分析显示，男性出生时的胸壁平均比女性出生时的胸壁更宽更长。胸大肌的尺寸及其插入位置在男性和女性的胸部之间并未发现有显著差异。男性乳头乳晕复合体（NAC）的长度和宽度往往较窄，乳头的突出程度低于女性 NAC。最后，IMF 被发现在男性和女性的胸部都位于第 5 肋和第 6 肋之间的间隙。我们的发现证实了男性和女性出生时的 IMF 位于第 5 肋和第 6 肋之间。这一事实证实了资深作者的男性化胸部技术，将男性化的 IMF 保持在与女性出生时的 IMF 大致相同的水平，并遵循胸大肌的边缘，以不同于先前报道的技术来定义最终的疤痕。
