ArticleAnnals of plastic surgery2025
Comparative Outcome Study of Gynecomastia Surgery and Gender-Affirming Mastectomy With 100% Nipple Preservation.
Article in Annals of plastic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A Systematic Review of Helium Plasma Radiofrequency (Renuvion).Annals of plastic surgery · 2025Pooled it
- Role of Ultrasonography in Perioperative Management of Suction-Assisted Lipectomy for Gynecomastia: A Prospective Study.Aesthetic plastic surgery · 2026Article
- Board-Based Medicine: The ASPS Position Statement on Gender-Affirming Surgery and the New Minimum Age of 19.Annals of plastic surgery · 2026Article
- Comparison of Circumareolar Mastopexy for Gynecomastia with a Semicircular Incision.Aesthetic plastic surgery · 2026Review
- A review of nipple-areola complex reconstruction and tattooing techniques.Gland surgery · 2026Review
- A Review of Mammaplasties With Measurements: Evaluating Autoaugmentation, Mesh, Acellular Dermal Matrix, and the Wise Pattern.Annals of plastic surgery · 2025Review
- Invited Commentary: The Case for Nipple Preservation Over Grafts in Gynecomastia Surgery.Annals of plastic surgery · 2025Article
- Changing Perspectives in Mastectomy: The Case for Nipple Preservation.Annals of plastic surgery · 2025Article
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Abstract
backgroundGynecomastia and gender-affirming top surgery share similarities in objectives. Traditionally, a subcutaneous mastectomy using a semicircular incision has been recommended for most gynecomastia patients. In recent years, mastectomies and nipple grafting have become the most popular treatment for gender-affirming top surgery. Nipple grafting is very debilitating to this unique body part, which also provides erogenous sensation. This study was undertaken to compare methods, complications, and outcomes using an approach that preserves nipples in 100% of patients.
methodsA retrospective study was conducted, comparing all gynecomastia patients and gender-affirming top surgery patients treated by the author over the period 2016-2024. Most (92%) gynecomastia patients were treated with liposuction in combination with a semicircular incision and subcutaneous mastectomy. Twelve top surgery patients (71%) were also treated with this method. Two gynecomastia patients and 5 top surgery patients with pendulous breasts underwent vertical mammaplasties incorporating a medial pedicle. A telephone survey was also administered.
resultsFifty-three patients were evaluated, including 36 gynecomastia patients and 17 top surgery patients. The complication rate was 21%. Three patients (6%) developed hematomas. Five patients (9%) underwent revisions. No patient experienced complications of the nipple/areola complex. All surveyed patients reported that nipple preservation was important. Two patients (11%) reported reduced nipple sensation after surgery. No patient reported scar dissatisfaction. Fifteen patients (83%) were comfortable exposing their chest after surgery, compared with 1 patient (6%) before surgery. DISCUSSION: Today, a major disparity exists in treatment recommendations, with almost all gynecomastia patients being offered nipple-preserving methods and the majority of top surgery patients undergoing mastectomies with nipple grafting, or even without grafting. In view of the importance of nipple sensation, and the success of an alternative approach, surgical priorities should be realigned to preserve nipple/areola complexes.
conclusionsNipple preservation is offered to all patients. Subcutaneous mastectomies are often sufficient, and limit scarring. Vertical mammaplasties with a medial pedicle are effective in patients with pendulous breasts. Liposuction is offered as a second-stage procedure, although many patients are satisfied with some residual breast fullness. The need for secondary surgery of the nipple/areola complex and scar revisions is minimized.
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