Outcomes of nipple–areola complex reconstruction in transgender chest masculinization using the free nipple graft technique: a cross-sectional study

The free nipple graft (FNG) technique, involving the removal of breast tissue and reattachment of the nipple-areola complex (NAC) as a full-thickness skin graft, is a widely utilized method in this surgery. This study aims to evaluate the outcomes of NAC reconstruction in transgender individuals who have undergone mastectomy using the FNG technique. This cross-sectional study involving transgender individuals aged 18 years and older who had undergone FNG masculinizing chest surgery at least six months prior. Data were collected from medical records and assessed using a subset of the BREAST-Q questionnaire, translated and validated for this context. The study included participants with a mean age of 21.20 years. The average follow-up duration was 11.20 months. Satisfaction with nipple appearance was high, with 52% of participants somewhat satisfied and 48% very satisfied. The average cosmetic score was 8.272. Common complications included seroma (28%) and contraction (12%). Minimal pain was reported by participants, with 60% never experiencing sharp breast pain and 68% never experiencing general breast pain. High satisfaction levels were noted for nipple and areola appearance and size, with 80% and 60% of participants finding them satisfactory, respectively. Overall breast appearance satisfaction was high, with 88% very satisfied. The FNG technique in masculinizing chest surgery yields high satisfaction with NAC appearance and sensation, overall breast appearance, and manageable pain levels, indicating its efficacy.