Reducing Partial Nipple Graft Necrosis Following Masculinizing Chest Reconstruction With Negative Pressure Wound Therapy
Adaah A. Sayyed, BS1, ZoŽ K. Haffner, BS1, Areeg A. Abu El Hawa, BS2, Susan Orra, MD1, Kenneth L. Fan, MD1, Gabriel Del Corral, MD1.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA.
Introduction: Despite a greater recognition of transgender care and advancements in gender-affirmation surgery, chest masculinization is still associated with an elevated rate of postoperative complications, such as nipple graft necrosis. Incidence of partial nipple graft necrosis following chest masculinization has been reported as high as 18.5% of cases. Benefits of negative pressure wound therapy (NPWT) include improved wound healing and graft take through an enhanced inflammatory response and reduction in shear forces, withdrawal of edematous fluid from the affected area, and promotion of wound bed contraction. In cases of breast reconstruction, NPWT use has been demonstrated to lower overall complication rates compared to use of standard wound care (SWC) dressings. Currently there is a paucity of literature regarding the role of NPWT application following chest masculinization surgery. Our study aims to evaluate the outcomes of NPWT use following chest masculinization with free nipple grafting (FNG) in reducing nipple graft necrosis. Methods: From January 2018 to November 2020, all transgender and non-binary patients who underwent chest masculinizing reconstruction with FNG by the senior author (GDC) were retrospectively reviewed. Patients were divided into two cohorts: those treated with (1) NPWT or (2) standard wound care (SWC). Data regarding demographics, comorbidities, operative details, and postoperative partial nipple graft necrosis were collected from the electronic medical record. Each complication was considered a separate event and counted once per breast. Results: A total of 131 patients were included in the study, of which 27.5% (n=36) received NPWT and 72.5% received SWC (n=95). Median age and BMI at time of surgery was 24 years (IQR 20,29) and 28.2 kg/m2 (IQR 24.2, 35) with no difference between cohorts (p=0.145, p=0.753, respectively). In the overall chest masculinization cohort, the median weight of resected breast tissue was 562 grams (IQR 430, 828) and was not significantly different between NPWT and SWC cohorts (562g vs. 576g; p=0.939). Only 12.5% of those receiving NPWT experienced partial nipple graft loss (n=9/72) compared to 24.7% in those receiving SWC (n=47/190; p=0.031). Additional analysis found that patients receiving NPWT experienced a lower incidence of partial nipple graft necrosis within all BMI categories (Figure 1). Conclusions: Our study findings illustrate that NPWT may help in reducing partial nipple graft necrosis as a postoperative complication in those undergoing chest masculinization with FNG compared to those receiving SWC. Prospective randomized studies can help further elucidate the outcomes of NPWT use following top surgery.
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