Shape, Position and Dimension of the Nipple Areola Complex in the Ideal Male Chest: A Quick and Simple Operating Room Technique

Original Article Breast Surgery
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Abstract

Introduction

The anatomical features of the chest identify an individual as male or female and even the smallest details of these features determine the appropriate appearance for each gender. In female-to-male patients, the creation of an aesthetically pleasing male chest is the most important step. Incorrect positioning of the nipple areola complex (NAC) on the chest wall and suboptimal shaping and sizing of the NAC are common pitfalls in male NAC creation.

Patients and Methods

We have analyzed the anatomical chest features of 26 water polo players, to verify our hypothesis of the relationship between the pectoralis major muscle and NAC and to create a method for repositioning the NAC that is applicable in the operating room, is easy, practical and reproducible without the use of formulas and based on an easily identifiable landmark.

Results

In our reference group, the NAC has a constant relationship with the pectoralis major muscle, positioned on average 3 cm medial to the lateral border of the pectoralis muscle and 2.5 cm above the inferior pectoralis major insertion. This supports our hypothesis and our surgical technique. We use the index finger to find a vertical axis and a line 2.5 cm above the inferior pectoralis shadow to find the horizontal axis. We also introduce a modification to the receiving site to recreate an oval areola more similar to that of an ideal male chest.

Conclusions

Our anatomical study and statistical analysis support a consistent relationship between the position and shape of the NAC and the borders of the pectoral muscle. We have used this relationship to develop our “trick,” which is easily applicable in the operating room to find the NAC position without using formulas and numbers. This method allowed us to place the NAC in a position very close to that of a typical male subject, and it permitted us to reduce the surgery time.

Level of Evidence IV

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Keywords

FTM top surgery Ideal male chest Chest wall contouring Female-to-male transsexuals Nipple areola complex NAC graft 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest to disclose.

References

  1. 1.
    Mett TR, Krezdorn N, Luketina R, Boyce MK, Henseler H, Ipaktchi R, Vogt PM (2017) Optimal positioning of the nipple–areola complex in men using the mohrenheim-estimated-tangential-tracking-line (METTLine): an intuitive approach. Aesthetic Plast Surg.  https://doi.org/10.1007/s00266-017-0941-9 PubMedGoogle Scholar
  2. 2.
    Agarwal CA, Wall VT, Mehta ST, Donato DP, Walzer NK (2017) Creation of an aesthetic male nipple areolar complex in female-to-male transgender chest reconstruction. Aesthetic Plast Surg.  https://doi.org/10.1007/s00266-017-0935-7 PubMedGoogle Scholar
  3. 3.
    Lo Russo G, Tanini S, Innocenti M (2017) Masculine chest-wall contouring in FtM transgender: a personal approach. Aesth Plast Surg 41(2):369–374CrossRefGoogle Scholar
  4. 4.
    Monstrey S, Selvaggi G, Ceulemans P, Van Landuyt K, Bowman C, Blondeel P, Hamdi M, De Cuypere G (2008) Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg 121(3):849–859CrossRefPubMedGoogle Scholar
  5. 5.
    Wolter A, Diedrichson J, Scholz T, Arens-Landwehr A, Liebau J (2015) Sexual reassignment surgery in female-to-male transsexuals: an algorithm for subcutaneous mastectomy. J Plast Reconstr Aesthet Surg 68(2):184–191CrossRefPubMedGoogle Scholar
  6. 6.
    Beer GM, Budi S, Seifert B, Morgenthaler W, Infanger M, Meyer VE (2001) Configuration and localization of the nipple–areola complex in men. Plast Reconstr Surg 108(7):1947–1952CrossRefPubMedGoogle Scholar
  7. 7.
    Murphy TP, Ehrlichman RJ, Seckel BR (1994) Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia. Plast Reconstr Surg 94(6):818–823CrossRefPubMedGoogle Scholar
  8. 8.
    Beckenstein MS, Windle BH, Stroup RT Jr (1996) Anatomical parameters for nipple position and areolar diameter in males. Ann Plast Surg 36(1):33–36CrossRefPubMedGoogle Scholar
  9. 9.
    Atiyeh BS, Dibo SA, El Chafic AH (2009) Vertical and horizontal coordinates of the nipple–areola complex position in males. Ann Plast Surg 63(5):499–502CrossRefPubMedGoogle Scholar
  10. 10.
    Shulman O, Badani E, Wolf Y, Hauben DJ (2001) Appropriate location of the nipple–areola complex in males. Plast Reconstr Surg 108(2):348–351CrossRefPubMedGoogle Scholar
  11. 11.
    Hage JJ, van Kesteren PJ (1995) Chest-wall contouring in female-to-male transsexuals: basic considerations and review of the literature. Plast Reconstr Surg 96(2):386–391CrossRefPubMedGoogle Scholar
  12. 12.
    Lindsay WR (1979) Creation of a male chest in female transsexuals. Ann Plast Surg 3(1):39–46CrossRefPubMedGoogle Scholar
  13. 13.
    Berry MG, Curtis R, Davies D (2012) Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience. J Plast Reconstr Aesthet Surg 65(6):711–719CrossRefPubMedGoogle Scholar
  14. 14.
    McGregor JC, Whallett EJ (2006) Some personal suggestions on surgery in large or ptotic breasts for female to male transsexuals. J Plast Reconstr Aesthet Surg 59:893–896CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Department Plastic and Reconstructive MicrosurgeryCareggi University HospitalFlorenceItaly

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