Novel Top Surgery in Small-Breasted Individuals with Gender Dysphoria: Periareolar Interlocking Suture and Waterjet-Assisted Liposuction.

[BACKGROUND] In small-breasted individuals with gender dysphoria (GD), the concentric periareolar approach is typically the preferred method for mastectomy. However, this method carries a notable risk of hypertrophic scars and changes in areolar dimensions. In this article, the authors introduce the periareolar interlocking suture (PIS) as a new scar-minimizing procedure with a low complication rate and high level of patient satisfaction.

[METHODS] The corresponding author (A.W.) performed a concentric periareolar mastectomy combined with PIS and waterjet-assisted liposuction in patients with small breasts (A to B cup) and good skin quality and elasticity. Outcome measures included complication rates, patient satisfaction (based on the BODY-Q Chest and Nipples scales and scar appearance), nipple sensitivity, and rate of surgical corrections.

[RESULTS] Between April of 2017 and December of 2023, the corresponding author (A.W.) conducted 2312 mastectomies in 1156 individuals with GD, with 410 breasts treated using concentric periareolar mastectomy combined with PIS and waterjet-assisted liposuction. The mean patient age was 23 years; the mean hospital stay was 4 days; and the mean operative time was 96.1 minutes. The overall complication rate was 7.8%, with acute hematomas occurring in 4.6% of cases. Secondary revisions were necessary in 2.2% of cases. Patient satisfaction, measured using the BODY-Q scale, was statistically significant and very high.

[CONCLUSIONS] Individuals with GD are well informed and increasingly demand aesthetically pleasing outcomes. Whenever feasible, procedures with minimal scarring are preferred. The technique presented here resulted in a high level of patient satisfaction, preserved nipple sensitivity, and a low rate of complications and secondary aesthetic corrections in a carefully selected cohort of patients with small breasts.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, IV.