Aesthetic Plastic Surgery

, Volume 43, Issue 5, pp 1195–1203 | Cite as

Nipple-Areolar Complex Position in Female-to-Male Transsexuals After Non-skin-excisional Mastectomy: A Case–Control Study in Japan

  • Yu Kagaya
  • Ichiro Shiokawa
  • Hiroki Karasawa
  • Kentaro Ono
  • Akira MomosawaEmail author
Original Article Breast Surgery



Mastectomy is performed in female-to-male transsexual (FTM TS) patients as a surgical treatment to make a female thorax resemble a male thorax; however, no studies have examined the nipple-areolar complex (NAC) position in FTM TS patients after mastectomy.

Patients and Methods

The NAC position in 41 FTM TS patients before and after non-skin-excisional mastectomy was examined and compared with that in 50 age- and BMI-matched biologically male subjects as controls. The factors affecting the NAC position after the operation were also examined and verified by multiple regression analysis.

Results and Conclusions

After non-skin-excisional mastectomy, the NAC in the FTM TS patients was positioned significantly more medially (horizontal NAC position ratio {(‘internipple distance’/‘width of thorax’) × 100} [HNPR]: preoperatively, 70.07% ± 4.19%; postoperatively, 63.28% ± 3.79%) and cranially (vertical NAC position ratio {(‘distance from sternal notch to nipple height’/‘distance from sternal notch to umbilicus’) × 100} [VNPR]: preoperatively, 43.87% ± 3.68%; postoperatively, 41.37% ± 3.15%). Postoperatively, the NAC in the FTM TS patients was located significantly more medially than that in the control subjects (HNPR: 63.28% ± 3.79% to 66.79% ± 4.82%), although the height of the NAC was the same. Multiple regression analysis revealed that the NAC position on breasts characterized by ptosis, a high projection, and lateral leaning (low skin elasticity and a substantial amount of skin between the nipples) tended to be positioned more medially after non-skin-excisional mastectomy. Laterally deviated eccentric circular type mastectomy may be a good option for FTM TS patients who have moderately sized breasts with such features.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Gender incongruence Gender dysphoria Female-to-male transsexual (FTM TS) Mastectomy Nipple-areolar complex (NAC) position 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose:

Ethical Approval

This case–control study was approved by the institutional review board of the participating institutions and conducted in accordance with the Declaration of Helsinki on investigations involving humans.

Informed Consent

Although informed consent was obtained in the form of an opt-out option on the Web site, for the two patients whose photographs were used in the present article, informed consent was obtained from each patient on an individual basis.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Yu Kagaya
    • 1
  • Ichiro Shiokawa
    • 2
  • Hiroki Karasawa
    • 3
  • Kentaro Ono
    • 4
  • Akira Momosawa
    • 2
    Email author
  1. 1.Division of Plastic and Reconstructive SurgeryNational Cancer Center HospitalTokyoJapan
  2. 2.Department of Plastic and Reconstructive SurgeryYamanashi University HospitalYamanashiJapan
  3. 3.Keiseikai ClinicOsaka-shiJapan
  4. 4.Skin Clinic FujiedaFujieda-shiJapan

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