Background: Most patients undergoing breast surgery with free nipple grafts lose nipple erection (NE) function. This study aimed to evaluate the effect of nerve preservation and reconstruction with targeted nipple-areola complex reinnervation (TNR) on NE following gender-affirming mastectomy with free nipple grafting.
Methods: Patients undergoing gender-affirming mastectomy with free nipple grafts were prospectively enrolled. Subjects who underwent TNR were compared with controls who did not undergo TNR. Postoperative patient-reported NE function was scored using a 4-point Likert scale. Objective NE evaluation consisted of the change in areola circumference and nipple height following cold application using a thermal device and 3-dimensional imaging.
Results: Twenty patients (11 subjects and 9 controls) with comparable age, body mass index, and mastectomy weight were included. At an average follow-up of 16.8 (±7.0) months, significantly more subjects reported NE than controls (72.8% versus 38.9%, = 0.03), with a higher median NE score (3 [range 1-4] versus 1 [range 1-2], = 0.0005). Following cold application, subjects had a greater mean reduction in areola circumference (-4.16 ± 3.3 versus -1.67 ± 1.9 mm, = 0.02) and a greater mean increase in nipple height (+0.86 ± 0.8 versus +0.37±0.3 mm, = 0.04) compared with controls. Improved patient-reported NE function correlated with better cold detection thresholds ( = 0.01).
Conclusions: TNR was associated with improved patient-reported and objective NE following gender-affirming mastectomy. Improved NE correlated with improved cold detection, suggesting the role of both sensory and autonomic innervation in mediating NE.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730083 | PMC |
| http://dx.doi.org/10.1097/GOX.0000000000006418 | DOI Listing |
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