Ferrin Peter C, Pua Ezra, Isbester Kelsey, Peters Blair R
From the Department of Surgery, Oregon Health and Science University.
Oregon Health and Science University School of Medicine.
Ann Plast Surg. 2024 Aug 1;93(2):189-193. doi: 10.1097/SAP.0000000000004004. Epub 2024 Jun 3.
Some patients pursuing gender-affirming mastectomy prefer to forgo autologous nipple and areolar reconstruction, instead choosing a "no nipple" option. The objective of this study is to evaluate the motives and influences contributing to this decision.
A retrospective survey-based study of patients undergoing gender-affirming mastectomy over a 4.6-year period was conducted. All patients were offered nipple and areolar reconstruction. A survey was distributed to those who elected to forgo nipple and areolar reconstruction exploring the factors influencing that choice and postoperative satisfaction.
Five hundred thirty-six patients underwent gender-affirming mastectomy and 13% chose to forgo nipple and areolar reconstruction. The survey response rate was 72%. Most respondents identified as nonbinary (48%) or transmasculine (42%). Body image, defined in the context of this study as an improvement in body image satisfaction due to achievement of a more gender-congruent appearance, was the most highly cited and most heavily weighted decision-making factor. Concerns about nipple graft outcomes were frequently cited as important but carried less weight. There were no differences between transmasculine and nonbinary patients in terms of motivations for choosing this surgical option. Fifty-eight percent of respondents pursued or planned to pursue chest tattoos, whereas 42% preferred no further chest modifications. Patient satisfaction was high postoperatively (98%), and 82% of respondents would choose to forgo nipple and areolar reconstruction again even if surgical outcomes of free nipple grafts were improved.
Gender-affirming mastectomy without nipple and areolar reconstruction was requested by 13% of patients presenting for gender-affirming chest surgery over the study period and had high postoperative satisfaction among patients who chose this option. This modification of gender-affirming mastectomy is a variation that surgical teams should be aware of. Many reasons to forgo nipple preservation were cited, most of which related to body image. Secondary factors were easier recovery and/or concern about outcomes of free nipple grafts. Many patients wished information about this surgical option was more widely available.
一些寻求性别确认性乳房切除术的患者更倾向于放弃自体乳头乳晕重建，而是选择“无乳头”方案。本研究的目的是评估促成这一决定的动机和影响因素。
对4.6年间接受性别确认性乳房切除术的患者进行了一项基于回顾性调查的研究。所有患者均接受了乳头乳晕重建。向那些选择放弃乳头乳晕重建的患者发放了一份调查问卷，以探究影响该选择的因素以及术后满意度。
536例患者接受了性别确认性乳房切除术，13%的患者选择放弃乳头乳晕重建。调查回复率为72%。大多数受访者认定为非二元性别（48%）或跨性别男性（42%）。在本研究背景下，身体形象被定义为由于实现了更符合性别认同的外观而使身体形象满意度得到改善，这是被提及最多且权重最大的决策因素。对乳头移植结果的担忧虽常被视为重要因素，但权重较小。跨性别男性患者和非二元性别患者在选择这一手术方案的动机方面没有差异。58%的受访者进行了或计划进行胸部纹身，而42%的受访者则不希望对胸部进行进一步修饰。患者术后满意度较高（98%），即使游离乳头移植的手术效果得到改善，82%的受访者仍会再次选择放弃乳头乳晕重建。
在研究期间，13%接受性别确认性胸部手术的患者要求进行无乳头乳晕重建的性别确认性乳房切除术，选择该方案的患者术后满意度较高。这种性别确认性乳房切除术的改良方案是手术团队应了解的一种变体。放弃保留乳头的原因有很多，其中大部分与身体形象有关。次要因素是恢复更容易和/或对游离乳头移植结果的担忧。许多患者希望有关这一手术方案的信息能更广泛地传播。
