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Background <p>Nipple-areola complex (NAC) reconstruction is widely considered a vital component of chest wall masculinization and has been associated with improvements in quality of life. However, emerging clinical observations suggest that some patients undergoing gender-affirming mastectomy elect to forgo nipple grafting altogether. To our knowledge, no prior studies have evaluated public perceptions of the importance of NAC reconstruction.</p> Methods <p>A ten-item questionnaire was randomly distributed to adults in the United States to assess demographics, prior experience with top surgery, and preferences regarding nipple preservation. In total, 560 individuals completed the survey, with 45% reporting prior top surgery and 48% considering top surgery. Of respondents who consulted a surgeon, only 50% reported discussion of foregoing NAC reconstruction as an option. Regarding the importance of nipples after surgery, 48% reported indifference, 29% considered them important, and 23% considered them unimportant.</p> Results <p>For respondents who would undergo NAC reconstruction, reasons included aesthetics (39%), desire to reduce chest volume without altering appearance (37%), fear of stigmatization (20%), and lack of awareness of the option to forego reconstruction (2%). For respondents who would forego NAC reconstruction, reasons included observing others do so (48%), feeling less conforming to gender constructs (41%), and concern about nipple discoloration (10%).</p> Conclusions <p>Although NAC reconstruction remains standard in chest wall masculinization, only 29% of respondents considered nipples very important. As interest in foregoing NAC reconstruction emerges in clinical practice, surgeons should ensure this option is consistently included in shared decision-making discussions.</p> Level of evidence: <p>Not gradable.</p>

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Crowdsourcing the perception of foregoing nipple-areola complex reconstruction during double incision mastectomy top surgery

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Olivier F. Noel,
  • Alexander Kammien,
  • Karen Bach,
  • Thien Nguyen,
  • Angie M. Paik

摘要

Background

Nipple-areola complex (NAC) reconstruction is widely considered a vital component of chest wall masculinization and has been associated with improvements in quality of life. However, emerging clinical observations suggest that some patients undergoing gender-affirming mastectomy elect to forgo nipple grafting altogether. To our knowledge, no prior studies have evaluated public perceptions of the importance of NAC reconstruction.

Methods

A ten-item questionnaire was randomly distributed to adults in the United States to assess demographics, prior experience with top surgery, and preferences regarding nipple preservation. In total, 560 individuals completed the survey, with 45% reporting prior top surgery and 48% considering top surgery. Of respondents who consulted a surgeon, only 50% reported discussion of foregoing NAC reconstruction as an option. Regarding the importance of nipples after surgery, 48% reported indifference, 29% considered them important, and 23% considered them unimportant.

Results

For respondents who would undergo NAC reconstruction, reasons included aesthetics (39%), desire to reduce chest volume without altering appearance (37%), fear of stigmatization (20%), and lack of awareness of the option to forego reconstruction (2%). For respondents who would forego NAC reconstruction, reasons included observing others do so (48%), feeling less conforming to gender constructs (41%), and concern about nipple discoloration (10%).

Conclusions

Although NAC reconstruction remains standard in chest wall masculinization, only 29% of respondents considered nipples very important. As interest in foregoing NAC reconstruction emerges in clinical practice, surgeons should ensure this option is consistently included in shared decision-making discussions.

Level of evidence:

Not gradable.