The circumareolar approach to gynecomastia and transgender surgery: modifications to provide correct nipple areolar complex position and shape.

South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie

PubMedID: 28876553

Jay T, Segwapa K. The circumareolar approach to gynecomastia and transgender surgery: modifications to provide correct nipple areolar complex position and shape. S Afr J Surg. 2017;55(1):16-20.
BACKGROUND
In surgery for gynaecomastia, excision with minimal scarring and correct position of the nipple areolar complex (NAC) are key to a successful outcome. We report on a pilot study on the use of a circumareolar excision and the use of mathematical vector calculation to position the NAC and execute surgery and report on the outcomes.

METHOD
From 2014 to 2015, the authors operated on 9 gynecomastia or transgender patients. Based on research performed by Gertrude Beer, Beckenstein and Shulman we designed a mathematical modification of the technique described by Persichetti to provide correct NAC positioning as well as aesthetically pleasing NAC shape. We utilised the technique in 6 patients, 4 males with gynecomastia and 2 transgender patients. Liposuction was performed as an adjunct as needed.

RESULTS
In 5 of the patients, the NAC did move in the direction of the desired vector. The NAC was on average within 0.4 cm of the desired nipple to mid-sternal position. The lateral movement averaged 0.6 cm. We found the modified circumareolar approach to deliver good aesthetic results with predictable NAC movement. Seroma formation was the most common complication.

CONCLUSION
The mathematically modified circumareolar approach to transgender and gynecomastia surgery may provide better aesthetic outcomes. Several factors need to be considered in deciding how the oval shaped vector should be designed intraoperatively. The study was limited by small sample size and short follow-up.