Li Karen, Rohrich Rachel N, Lava Christian X, Marshall Sara, Zheng Wynne, Falconer Rebecca, Kapp Kelly, De La Cruz Lucy, Greenwalt Ian, Fan Kenneth L
From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
Georgetown University School of Medicine, Washington, DC.
Plast Reconstr Surg Glob Open. 2025 Sep 23;13(9):e7106. doi: 10.1097/GOX.0000000000007106. eCollection 2025 Sep.
Patients who desire a flatter chest contour after mastectomy can opt for aesthetic flat closure (AFC) instead of traditional autologous and breast implant options that recreate the breast mound. AFC is an evolving area of reconstructive surgery in breast reconstruction, and there have been no nipple-sparing techniques demonstrated in the current literature to date. We thus present an AFC surgical technique by the senior author for the oncoplastic gender-nonconforming patient population. Technically, this approach uses an inferior adipodermal flap to preserve the nipple-areola complex, similar to an inferior pedicle-based reduction mammaplasty, while achieving a masculinized chest contour. Key surgical pearls include preoperative planning to align patient goals with chest wall aesthetics, careful intraoperative assessment to ensure adequate nipple perfusion, and intraoperative flexibility in nipple resizing, reshaping, and repositioning to align with the patient's wishes. The technique also allows for customization of chest contour, enabling the creation of a completely flat chest or a small breast mound based on individual patients' preferences. Patients requiring extensive tissue removal or contraindications for breast-conserving surgery should be excluded due to the risk of inadequate nipple perfusion. This is the first and only nipple-sparing AFC technique in the current literature, addressing a need in reconstructive breast surgery for gender-nonconforming populations.
乳房切除术后希望胸部轮廓更平坦的患者可以选择美学扁平闭合术（AFC），而不是采用重建乳房隆起的传统自体组织和乳房植入物方法。AFC是乳房重建中整形手术的一个不断发展的领域，目前文献中尚未有保留乳头技术的相关报道。因此，我们在此介绍资深作者为非顺性别肿瘤整形患者群体设计的一种AFC手术技术。从技术层面讲，这种方法使用下腹部脂肪皮瓣来保留乳头乳晕复合体，类似于基于下蒂的乳房缩小整形术，同时实现男性化的胸部轮廓。关键的手术要点包括术前规划，使患者目标与胸壁美学相匹配；术中仔细评估，确保乳头有足够的血供；以及术中在乳头大小调整、塑形和重新定位方面保持灵活性，以符合患者意愿。该技术还允许对胸部轮廓进行定制，能够根据患者个人喜好打造完全平坦的胸部或小乳房隆起。由于存在乳头血供不足的风险，需要广泛切除组织或有保乳手术禁忌证的患者应被排除在外。这是目前文献中首例也是唯一的保留乳头的AFC技术，满足了非顺性别群体乳房重建手术的需求。
