Position of male nipple areolar complex in masculinizing chest contouring surgery-a new technique from the constant anatomical relationship with pectoralis major muscle.

Background: As diverse gender identities and sexual orientations gain increasing recognition and acceptance worldwide, the demand for gender-affirming procedures has risen. Among these procedures, chest contouring surgery is the most common and often the first undertaken by transgender men. Goals of this procedure is to remove breast tissue, excess skin and relocate the nipple-areolar complex (NAC) while aesthetically placing surgical scar. The accurate placement of the NAC in masculine chest wall contouring surgery is a critical step in achieving a natural appearance. This study aims to identify the optimal intraoperative NAC position relative to the pectoralis major muscle, yet no standard method exists. Methods: A descriptive cross-sectional study. Thirty-eight healthy male volunteers (76 breasts) with normal chest anatomy were examined for surface anatomical parameters and underwent ultrasound to measure distances from the (I) lateral border and (II) inferior border of the pectoralis major muscle to the nipple. These distances were measured by ultrasound from perpendicular point on skin to nipple in supine position with 90-degree shoulder abduction. The relationship between the NAC and the pectoralis major muscle was analyzed to develop a reproducible and practical intraoperative technique for locating the NAC. Results: The mean age of participants was 29.5 years, with an average body mass index (BMI) of 22 kg/m Conclusions: The consistent anatomical relationship between the NAC and the pectoralis major muscle provides a reliable, reproducible method for NAC positioning in chest masculinization surgery. These findings can guide nipple creation and areolar grafting techniques, improving surgical precision and aesthetic outcomes.