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Neurotized Chest Masculinization For Improving Nipple Sensation: Survey Results
Alexandra Naides, BFA1, John Cece, MD1, Kathryn Doshi, PA-C2, Jonathan D. Keith MD FACS, MD, FACS3,2.
1Rutgers New Jersey Medical School, Newark, NJ, USA, 2East Coast Advanced Plastic Surgery, Livingston, NJ, USA, 3Rutgers New Jersey Medical School, Livingston, NJ, USA.

Introduction: The double-incision with free nipple grafting (FNG) technique is often used for trans men and non-binary patients who want what is considered a more masculine chest contour. One of the most commonly cited disadvantages of this procedure is the lack of nipple sensation post-operatively. To overcome this barrier, the authors use a microsurgical nerve graft to reinnervate the nipple graft and improve post-operative sensation. The aim of this study is to evaluate patient sensation and satisfaction.
Methods: Patients who met the World Professional Association for Transgender Health (WPATH) criteria for top surgery and who underwent neurotized chest masculinization with senior author (J.D.K.) with at least three months follow-up were included. All patients were emailed a link to a 12-question survey that sought information about the patientís post-operative sensation and its impact on their sexual satisfaction. Except for three demographic questions, all questions used a 4 or 5-point Likert scale. For questions assessing post-operative sensation and satisfaction, patients were asked to answer thinking of the past week and if sensation was not equal bilaterally, to evaluate the answer thinking of the side with less feeling. A total of 42 patients with at least 3-month follow-up were sent the survey.
Results: A total of 21 patients responded to the survey for a 50% response rate. The average age of respondents at the time of surgery was 24.1 years with an average follow-up of 199 days. Three patients were current or former smokers and two patients identified as obese. 71.4% of patients had "complete feeling" in their nipples pre-operatively while 0% had "no feeling" in their nipples. When asked, "Overall, how much feeling do you have in your nipples?" post-operatively, 9.5% of respondents had "a lot of feeling" while 52.4% had "no feeling." The responses to the question, "How much feeling do you have if you touch your nipples lightly?" were similar, except 33.3% of patients had "a little feeling" compared to 19.1% in the previous question. While no patient answered as having "complete feeling" to any of the post-operative questions regarding different forms of sensation, 33% of patients were either "very satisfied" or "somewhat satisfied" with the overall sensation (feeling) in their nipples. 47.6% of patients were "neither satisfied no dissatisfied." Similarly, 66.7% of patients stated that the loss of nipple sensation did not affect their sexual life, suggesting that other factors may play a greater role in overall sexual satisfaction. However, the loss of sensation had a negative effect on the sexual satisfaction of 3 patients. Patients who did have nipple sensation were asked when they first noticed the return of feeling and the answers ranged from 1-2 months to 6-7 months post-op.
Conclusion: Neurotized chest masculinization is a safe and effective method of reinnervating free nipple grafts. With enough post-operative follow-up time, this technique has the potential to increase overall nipple sensation and prove post-operative sexual satisfaction.


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