Was putting nipple grafts back on actually required?

Question

I am a trans man. I also have hidradenitis supperativa- which affected my breasts. During the consultation for my mastectomy (treating the dysphoria and functioning as radical removal for the HS), I told my surgeon i didnt want the nipple grafts, because i have had so many cysts on the areolas (and subsequent scarring). he told me that he wasnt allowed to not put them back on. Was the graft actually necessary? The scarring is now MUCH more visible, and i dont know where to go from here

Krishna Vyas, MD, PhD, MHS · Answer

Thank you for your question. I’m sorry that you’ve experienced difficulty with hidradenitis suppurativa, particularly as it impacted both your breasts before surgery and your recovery after masculinizing top surgery. The decision to replace the nipples during top surgery is ultimately a shared decision between the patient and their surgeon. If your preference at the time was to avoid replacing them&mdash;especially due to cystic changes and scarring&mdash;then nipple grafts may not have been necessary. In such cases, tattoos (typically done around one year post-op) could have been a viable option instead. I personally respect my patients' decisions on whether to reconstruct the areolas and nipples. In my practice, I offer multiple options to patients including nipples or not; liposuction or not; targeted nipple reinnervation or not. 
At this stage, you could consider excising the cystic and scarred areola skin to remove any affected tissue, which would leave a linear scar (which could be tattooed later if you desire). 
Krishna Vyas, MD, PhD, MHSHarvard and Mayo Clinic Trained Aesthetic and Plastic SurgeonNew York, New York

Elizabeth Kiwanuka, MD, PhD · Answer

It's unfortunate that you were told nipple grafts were mandatory despite expressing your concerns and preferences. In cases where patients have specific medical or personal reasons for not wanting nipple grafts, it's important for surgeons to respect their wishes and discuss alternative options.
While nipple grafts are a common part of top surgery, they are not always necessary for achieving satisfactory results, especially if a patient has concerns about potential complications or existing medical conditions like Hidradenitis Suppurativa (HS).
Given your history of HS and the risk of cysts and scarring on the areolas, it's understandable why you would prefer to avoid nipple grafts. However, it's concerning that your surgeon insisted on their placement despite your objections.
Moving forward, if you're unhappy with the appearance of your chest following surgery and the visibility of scarring, it's essential to seek a second opinion from another qualified surgeon experienced in revision procedures. They can assess your situation, discuss potential options for improving the appearance of your chest, and address any concerns you may have.
In some cases, scar revision procedures or other techniques may be available to help minimize the visibility of scars and achieve a more aesthetically pleasing result. Communication with your surgeon about your concerns and goals is key to finding a solution that meets your needs and helps alleviate any distress you may be experiencing.

Russell Sassani, MD · Answer

Thank you for your question. I'm sorry you have had so much trouble in the past with hidradenitis-suppurativa, especially as it has affected your breasts preoperatively and also your recovery from your masculinizing top surgery. The decision to replace the nipples at the time of top surgery really is a decision made between the patient and their surgeon. If your desire at the time of surgery was to not replace them (especially because of the history of cystic changes and scarring), then the nipples did not need to be replaced and could very well have been tattooed instead (typically one year postop). Your option at this point is to excise the cystic and scarred areola skin in an effort to remove all of the affected areola skin. This will however leave a (hopefully) barely visible linear scar that could then be tattooed about a year later.

Jaime Caloca, Jr., MD · Answer

Every surgeon has his protocols and restrictions. I personally accept my patient's decision on wether or not to reconstruct the areolas and nipples. If you do not want Areolas and nipples, you simply sign the special informed consent that states that it is not "normal" but desired and your personal preference. grafts were necessary for the surgeon who performed them as part of his protocol, not for your personal preference. I would need to see photos in order to further advise.

Was putting nipple grafts back on actually required?

Answers (4)

Answer: No Nipple grafts is OK

Answer: No Nipple grafts is OK

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Was putting nipple grafts back on actually required?

Answers (4)

Answer: No Nipple grafts is OK

Answer: No Nipple grafts is OK

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Recommended reading

Everything you need to know about Masculinizing Top Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.