Blears Elizabeth E, Remy Katya, Diaconu Silviu, Valerio Ian L, Gfrerer Lisa
Department of Plastic & Reconstructive Surgery, Tower Health Hospital System, West Reading, Pennsylvania, USA.
Department of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Microsurgery. 2025 May;45(4):e70060. doi: 10.1002/micr.70060.
Targeted nipple areola complex (NAC) reinnervation (TNR) to restore nipple and chest sensation has been previously described in patients undergoing breast reconstruction and gender-affirming mastectomy. A healthy 32-year-old male, with grade II gynecomastia with severe skin laxity and a BMI of 25 kg/m, underwent bilateral mastectomy with free nipple grafting (FNG) for persistent gynecomastia and chest wall soft tissue laxity. The mastectomy weight was 242.5 (range: 242-243) grams. Three lateral intercostal nerves (3rd, 4th and 5th) were preserved and directly coaptated to the new NAC on each side. Quantitative and patient-reported sensory evaluation was conducted at 18 months follow-up, revealing a median monofilament detection threshold of 3.61 (range: 2.83-3.61) at the NAC and 2.83 (2.83-3.61) at the chest wall as well as pain from pressure at a median of 100.0 kPa (range: 77.4-122.5) at the NAC and 151.5 kPa (range: 116.6-183.3) at the chest. While the median two-point discrimination was 3.0 cm (range: 1.5-4.0) at the chest wall, two-point discrimination could not be detected at the NAC. The patient was "very satisfied" with nipple and chest sensation and did not report any nipple hypersensitivity, nipple/chest pain, or phantom sensation/pain. TNR was able to restore various quantitative and patient-reported sensory functions at the NAC and chest with high patient satisfaction. This report provides the first quantitative sensory outcomes from TNR for restoration of sensation after mastectomy for the treatment of gynecomastia in a male patient.
先前已有报道，在接受乳房重建和性别确认乳房切除术的患者中，采用靶向乳头乳晕复合体（NAC）再支配术（TNR）来恢复乳头和胸部感觉。一名32岁健康男性，患有II级男性乳房肥大，伴有严重皮肤松弛，体重指数为25kg/m²，因持续性男性乳房肥大和胸壁软组织松弛接受了双侧乳房切除术及游离乳头移植（FNG）。乳房切除术切除的组织重量为242.5（范围：242 - 243）克。保留了三根肋间外侧神经（第3、4和5肋间神经），并将其直接与每侧新的NAC进行吻合。在18个月的随访中进行了定量和患者报告的感觉评估，结果显示，NAC处单丝检测阈值中位数为3.61（范围：2.83 - 3.61），胸壁处为2.83（2.83 - 3.61）；NAC处压力疼痛阈值中位数为100.0kPa（范围：77.4 - 122.5），胸部为151.5kPa（范围：116.6 - 183.3）。胸壁处两点辨别觉中位数为3.0cm（范围：1.5 - 4.0），而在NAC处未检测到两点辨别觉。患者对乳头和胸部感觉“非常满意”，未报告任何乳头过敏、乳头/胸痛或幻肢感觉/疼痛。TNR能够恢复NAC和胸部的各种定量及患者报告的感觉功能，患者满意度高。本报告提供了首例男性患者因治疗男性乳房肥大行乳房切除术后采用TNR恢复感觉的定量感觉结果。
