The double incision mastectomy with free nipple graft(DIFNG)remains the most widely performed technique in gender-affirming chest surgery.However,as patient goals and models of gender-affirming care have evolved,a mor...The double incision mastectomy with free nipple graft(DIFNG)remains the most widely performed technique in gender-affirming chest surgery.However,as patient goals and models of gender-affirming care have evolved,a more individualized,patient-centered approach has emerged.This study reviews historical and current trends in the literature and retrospectively examines 250 consecutive gender-affirming chest surgeries performed by the senior author to assess the breadth of surgical techniques utilized beyond the traditional DIFNG.A total of 70 cases(28%)employed alternative approaches,including double incision without nipple grafts,keyhole,buttonhole,nipple-sparing mastectomy,targeted nipple reinnervation,breast reduction,radical reduction,and mastopexy.These variations reflect a growing diversity in aesthetic,functional,and psychosocial goals,including preservation of nipple sensation,minimized scarring,the option to forgo nipple reconstruction,and maintaining the potential for chest-feeding.This paper outlines the indications and technical considerations for each method and presents a decision-making algorithm to guide individualized surgical planning.As the field of gender-affirming surgery continues to evolve,expanding the operative toolkit is essential to support patients across the gender spectrum and deliver affirming,patient-specific outcomes.展开更多
文摘The double incision mastectomy with free nipple graft(DIFNG)remains the most widely performed technique in gender-affirming chest surgery.However,as patient goals and models of gender-affirming care have evolved,a more individualized,patient-centered approach has emerged.This study reviews historical and current trends in the literature and retrospectively examines 250 consecutive gender-affirming chest surgeries performed by the senior author to assess the breadth of surgical techniques utilized beyond the traditional DIFNG.A total of 70 cases(28%)employed alternative approaches,including double incision without nipple grafts,keyhole,buttonhole,nipple-sparing mastectomy,targeted nipple reinnervation,breast reduction,radical reduction,and mastopexy.These variations reflect a growing diversity in aesthetic,functional,and psychosocial goals,including preservation of nipple sensation,minimized scarring,the option to forgo nipple reconstruction,and maintaining the potential for chest-feeding.This paper outlines the indications and technical considerations for each method and presents a decision-making algorithm to guide individualized surgical planning.As the field of gender-affirming surgery continues to evolve,expanding the operative toolkit is essential to support patients across the gender spectrum and deliver affirming,patient-specific outcomes.
