Yin-Yang nipple reconstruction technique/gender neutral nipple reconstruction

Nipple-areola reconstruction is an integral part of breast reconstruction surgery. It has been shown to improve psychological and psychosexual outcomes after breast cancer surgery. There are many techniques that describe reconstruction of the nipple-areola complex including local flaps, free nipple grafts, tattooing, and combinations of all these. In transgender men, there is very little data available on chest disparity and nipple-areola reconstruction. However, it is now known that most surgeons prefer to use free nipple grafting over other techniques to accomplish their goals in chest masculinization. We present a case in which our patient who was in a same sex relationship had right sided breast cancer and was due for a modified radical mastectomy on the right side and a prophylactic mastectomy on the left side. She did not want breast mound reconstruction but wanted to keep her nipples with a more masculine appearing chest. Since we had only one native nipple to work with, we developed a novel design to accomplish our reconstructive goal. We decided to call this technique the Yin-Yang nipple-areola reconstruction based on its design pattern. This technique is easily reproducible and is based on the principles of free nipple grafting offering all its benefits. It can be applied on a wider set of patients; however, a larger cohort, longer follow-up time and comparison with other techniques need to be done.

Level of evidence: Level V, therapeutic study.