Intercostal Nerve Transfer as a Novel Technique for Sensation Preservation in Gender-affirming Subcutaneous Mastectomy

Chest-wall contouring surgery is an important step in the transitional journey of many transgender individuals who choose to undergo masculinization procedures. Traditional gender-affirming chest surgery does not include reinnervation of the nipple-areolar complex (NAC) or the mastectomy skin flaps and risks partial or complete denervation of these areas. Efforts to restore sensation have emerged leading to various sensory nerve transfer techniques including direct neurorrhaphy to the repositioned NAC or to underlying dermatosensory elements. Here, we describe a novel technique in which we perform a nerve transfer from the anterior lateral branch of the fourth intercostal nerve (of the breast parenchyma to be resected) to the anterior lateral branch of the third or second intercostal nerve in the mastectomy skin flap. There has been no increased risk of complications, and results so far are promising. As we continue to collect long-term outcome data, the effectiveness of NAC reinnervation using this technique will be presented in a forthcoming publication.