Analysis of Nipple-Areola Complex Localization Using Male Cadavers: Considerations for Gender-Affirming Surgery

Aesthetic preferences for male breast: Analysis of 2282 surveys on the Chinese population

Background

As the prevalence of male breast surgery rises in China, there is a growing need to further investigate the aesthetic standards associated with male breasts among Chinese population.

Method

An interactive online survey featuring computerized images of a Chinese male breast was developed. Various attributes of male breasts were manipulated through digital editing using imaging software (Adobe Photoshop CS5; Adobe Systems, Inc., San Jose, Calif.). Participants were asked to evaluate the images and identify the most attractive male breast. Demographic information was gathered, and analysis of variance was employed to clarify preferences regarding male breast aesthetics.

Results

A total of 2282 complete responses were obtained. Of these, 1244 (54.5%) were from female participants, while 1038 (45.5%) were from male participants. In the frontal view, 66.17% of respondents favored a 2 cm nipple-areola complex (NAC), and 72.6% preferred a 5/8 NN-to-Chest ratio. In the lateral view, 57.8% preferred a flat breast projection, and 54.29% favored a 30° superior pole projection angle. Significant correlations were identified between gender, age, practice type and marital status.

Conclusion

Our study outlines the characteristics of an aesthetically appealing male breast. The analysis of the 2282 survey responses can provide valuable insights for surgical decision-making in chest contouring and reshaping procedures.

Linear Regression Algorithm for Male Nipple-Areolar Complex Anthropometry and Placement, Using Body Mass Index

INTRODUCTION

The nipple-areolar complex (NAC) is important from an aesthetic and functional standpoint for both sexes; however, methodology for NAC placement in men is less established. The objectives of this research are to determine normal measurements for NAC in the male Mexican population, its association with body mass index (BMI), and age, as well as presenting a reliable linear regression model for preoperative planning and placement.

METHODS

This study was carried out on the male population of the State of Mexico. NAC anthropometry was performed on 385 adult males. Descriptive statistics were used to determine measures of central tendency and dispersion. Spearman correlation test was performed in order to evaluate the linear association between age and BMI with anthropometry, and a linear regression model was generated for the measured variables. Finally, the predicted and measured values were compared.

RESULTS

BMI is strongly correlated with NAC anthropometry, an association that is independent from age. NAC diameter was also independent from BMI and age, 2.25 cm being the average.

CONCLUSION

We provide the anthropometric values obtained, and a linear regression equation which might be used in preoperative planning to determine optimal NAC placement. This method covers a wide range of BMI and age values.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Simultaneous Treatment of Pseudo-gynecomastia and Lateral Chest in Patients with Massive Weight Loss

BACKGROUND

Pseudogynecomastia in MWL patients is characterized by excess skin in chest, lateral chest, axilla and upper abdomen without enlargement of the breast glandular component. The aim of this work was to study long-term aesthetic outcomes of correction of severe pseudogynecomastia post-weight loss with inferior pedicle technique with some refinements.

METHODOLOGY

This prospective study included 15 patients underwent chest contouring after massive weight loss within period of 2 years between January 2022 and January 2024. All patients were subjected to local examination (position of nipple-areola complex and degree of ptosis and chest anthropometry) and photographic assessment, and pre- and postoperative results were compared. Patient satisfaction survey was done.

RESULTS

The ages ranged from 20 to 45 years (mean 32.67 years), the previous weight ranged with mean 158.8, the mean current weight was 87.53, and the mean BMI was 28.49. The time of weight loss ranged from 8 to 48 months (mean 20.07 months), and the duration of weight stability ranged from 6 to 24 months with mean 10.0 months. Regarding the complications, no major complications required readmission, four patients had minor complications (26.7%), one (6.7%) case had asymmetry of the NAC, one (6.7%) case had minor hematoma, one (6.7%) case had seroma, and one (6.7%) case had partial wound dehiscence. The overall satisfaction rate was high.

CONCLUSION

Patient satisfaction with male chest contouring for pseudogynecomastia following significant weight loss is excellent. In this study, we provide a reliable technique for management of pseudogynecomastia in post-MWL with good outcomes.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Techniques for Preserving the Nipple Areolar Complex in Chest Masculinization for All Chest Sizes

Current literature on gender-affirming top surgery techniques predominantly focuses on achieving optimal binary male aesthetic outcomes. However, goals for surgery are unique, and preservation of the nipple-areolar complex (NAC) for aesthetics and sensation can be of primary importance to patients. This paper provides an algorithm for preserving the NAC based on chest size and native NAC position. Written consent was obtained for all before and after patient photos. Photos were taken as part of patient care and documentation from one surgeon at Women's College Hospital in Toronto, Canada, between January 2020 and March 2022. Four techniques are highlighted in detail in this report: (1) keyhole (subcutaneous) mastectomies, (2) periareolar mastectomies, (3) nipple-preserving double-incision mastectomies, and (4) inverted T mastectomies. Current literature for top surgery focuses primarily on double-incision mastectomies with free nipple grafts or a smaller subset of periareolar and keyhole mastectomies. We have outlined several techniques to preserve the NAC, and an algorithm has been recommended based on chest size and preoperative NAC position. NAC preservation is possible for most chest sizes when performing masculinizing chest surgeries. The algorithm we have described provides guidance for surgeons to choose which technique to use based on the patient's breast volume, ptosis, and NAC position to preserve the entire NAC.

The clinical anatomy fellowship: A participants' perspective

Kansas City University offers a Clinical Anatomy Fellowship which enrolls nine medical students during each academic year and provides training in research, teaching, and advanced anatomical topics. The Fellows practice as novice educators, working alongside Anatomy faculty to teach medical students in the Gross Anatomy laboratory. However, little has been reported related to Fellowship participation and success outcomes. This survey-based study was designed to explore (1) student motivation(s) for pursuing the Fellowship, (2) benefits of participation, and (3) the perceived impact on residency applications and career success. Three unique populations were surveyed. The most important factors driving application to the Fellowship were a desire to increase competitiveness in the residency application process (Likert mean score 4.7-5.0) and a passion for Anatomy (Likert mean score 4.3-4.7). Taking a year away from the College of Osteopathic Medicine curriculum (Likert mean score 4.4) and delaying clinical exposure (Likert mean score 4.2) were the most important deterrents to application. The most reported benefits after program completion included opportunities to build a strong residency application (44% and 50% of Fellows), conduct research (44% and 45% of Fellows), and participate in teaching (11% and 50% of Fellows). 73% of past Fellows matched into their top specialty of choice. Flexibility in the program allows participants to individualize their Fellowship experience to address their personal goals related to residency applications and careers as future physicians. As the results suggest, the Clinical Anatomy Fellowship benefits Fellows, signaling other medical institutions to consider adopting a similar program.