Learning Curve for Sensory Preservation after Transgender Mastectomy Using Targeted Nipple Reinnervation with Direct Nerve Coaptation.

Overview

abstract

BACKGROUND: The authors describe the learning curve for nerve dissection during targeted nipple-areola complex (NAC) reinnervation (TNR) in gender-affirming mastectomy (GAM), allowing for primary use of direct nerve coaptation. Postoperative sensory outcomes between direct nerve repair and allograft use are analyzed. METHODS: Quantitative sensory testing and patient-reported outcomes were compared between 3 groups of 20 patients each ( n = 60): GAM plus TNR with nerve allograft reconstruction (group 1); GAM plus TNR with direct coaptation (group 2); and a control group, GAM without TNR (group 3). RESULTS: All preoperative sensory testing was comparable between groups. Starting 3 months postoperatively and throughout the study period, NAC and chest sensation in groups 1 and 2 were improved as compared with group 3. At 12 months postoperatively, 67% of group 1, 100% of group 2, and 17.5% of control patients demonstrated NAC light touch sensation at their preoperative baseline ( P < 0.05). Chest light touch was comparable between groups 1 and 2 (81.6% versus 90.9%; P = 0.46) and significantly worse in group 3 (62.5%; P = 0.033). Quantitative sensory testing results correlated with light touch sensory outcome. The majority of patients reported a lot or complete NAC light touch sensation in group 1 (75%) and group 2 (95%), as compared with group 3 (4%); 86.7% of group 1 and 100% of group 2 reported some degree of erogenous sensation, compared with 38% of group 3 ( P < 0.05). CONCLUSIONS: TNR is efficacious in restoring NAC and chest baseline sensation. Direct repair and allograft reconstruction are feasible options with comparable long-term sensory outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.