Learning Curve for Sensory Preservation after Transgender Mastectomy using TNR (Targeted Nipple Areola Complex Reinnervation) with Direct Nerve Coaptation.
Academic Article
Overview
abstract
INTRODUCTION: We 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 (QST) and patient reported outcomes were compared between three groups of 20 patients each (n=60): GAM+TNR with nerve allograft reconstruction (group 1), GAM+TNR with direct coaptation (2), and control group GAM -TNR (3). RESULTS: All preoperative sensory testing was comparable between groups. Starting 3 months postoperatively and throughout the study period, NAC and chest sensation in group 1 and 2 were improved as compared to 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% vs 90.9%, p=0.46) and significantly worse in group 3 (62.5%, p=0.033). QST 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 to group 3 (4%). 86.7% of group 1 and 100% of group 2 reported some degree of erogenous sensation, compared to 38% of group 3 (p<0.05). CONCLUSION: TNR is efficacious in restoring NAC and chest baseline sensation. Direct repair and allograft reconstruction are feasible options with comparable long term sensory outcomes.
