From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston.
Division of Plastic and Reconstructive Surgery, University of Massachusetts Medical Center, Worcester, MA.
Ann Plast Surg. 2024 Apr 1;92(4):383-388. doi: 10.1097/SAP.0000000000003821.
We evaluated patient-reported outcomes to assess for patient and procedural factors associated with postchest masculinization subjective nipple sensation. Patients who underwent double-incision or periareolar mastectomies for chest masculinization by a single senior surgeon (2015-2019) were surveyed at 2 time points regarding postoperative nipple sensation and satisfaction, including patient-reported outcomes using BODY-Q modules (Q-Portfolio.org). Demographic, operative, and postoperative variables were obtained from medical records. Patients were stratified according to survey responses. Univariate and multivariate analyses were performed.Response rate was 42% for survey 1 and 22% for survey 2. Of the 151 survey 1 responders, 138 (91.4%) received double-incision mastectomies and 13 (8.6%) received periareolar mastectomies. Among Survey 1 responders, 84.6% periareolar patients and 69.6% double-incision patients reported "completely" or "a little" nipple sensation preservation, and the difference trended toward significance (P = 0.0719). There was a stepwise increase in proportion of patients reporting sensation with greater recovery time until response to survey 1. Obesity (P = 0.0080) and greater tissue removed (P = 0.0247) were significantly associated with decreased nipple sensation. Nipple satisfaction scores were significantly higher for patients reporting improved nipple sensation (P = 0.0235). Responders to survey 2 who reported greater satisfaction with nipple sensation were significantly more likely to report preserved sensitivity to light touch (P = 0.0277), pressure (P = 0.0046), and temperature (P = 0.0031). Preserved erogenous sensation was also significantly associated with greater satisfaction (P = 0.0018).In conclusion, we found that nipple sensation may be associated with postoperative nipple satisfaction. Operative techniques to optimize nipple sensation preservation may improve this population's postoperative satisfaction.
我们评估了患者报告的结果,以评估与术后胸部男性化主观乳头感觉相关的患者和程序因素。由一位资深外科医生(2015-2019 年)对接受双切口或乳晕周围乳房切除术进行胸部男性化的患者进行了两次调查,调查内容包括术后乳头感觉和满意度,包括使用 BODY-Q 模块(Q-Portfolio.org)进行的患者报告结果。从病历中获得了人口统计学、手术和术后变量。根据调查结果对患者进行分层。进行了单变量和多变量分析。第一次调查的回复率为 42%,第二次调查的回复率为 22%。在第一次调查的 151 名回复者中,138 名(91.4%)接受了双切口乳房切除术,13 名(8.6%)接受了乳晕周围乳房切除术。在第一次调查的回复者中,84.6%的乳晕周围患者和 69.6%的双切口患者报告“完全”或“有点”乳头感觉保留,差异有统计学意义(P=0.0719)。随着回复第一次调查的恢复时间的增加,报告感觉的患者比例呈逐步增加趋势。肥胖(P=0.0080)和切除组织越多(P=0.0247)与乳头感觉下降显著相关。报告乳头感觉改善的患者的乳头满意度评分显著更高(P=0.0235)。对第二次调查中报告乳头感觉满意度更高的患者进行分析,发现他们对轻触(P=0.0277)、压力(P=0.0046)和温度(P=0.0031)的敏感性显著更高。保留性感觉也与更高的满意度显著相关(P=0.0018)。总之,我们发现乳头感觉可能与术后乳头满意度相关。优化乳头感觉保留的手术技术可能会提高该人群的术后满意度。