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Background <p>Masculinizing top surgery is the most prevalent gender-affirming procedure offered to transgender and gender diverse individuals, most commonly via gender-affirming mastectomy and free nipple grafting. Our institution presents a novel technique for gender-affirming top surgery, adapted from the modified Robertson technique for reduction mammoplasty. Our approach preserves a sensate and dynamic nipple using an inferiorly-based, bell curve pedicle.</p> Methods <p>A retrospective chart review was conducted including all patients who underwent the Lahey modification technique for gender-affirming top surgery by a single surgeon at an academic hospital in Massachusetts from October 2018 to November 2024. Patient characteristics, intra-operative data, and clinical outcomes were analyzed utilizing descriptive statistics and univariate logistic regression. Outcomes were stratified by resection weight greater or less than the mean (<i>x̄</i> = 571.5&#xa0;g) to inform patient selection.</p> Results <p>Thirty-eight patients (72 nipples) were included in this study. The median length of follow-up was 5 months (range 1&#xa0;week–60&#xa0;months). In total, there was partial necrosis of seven nipples (9.7%), decreased sensation in seven nipples (9.7%), and complete loss of sensation in one nipple (1.4%). None of the patients experienced complete nipple loss. There was an overall high rate of subjective patient satisfaction.</p> Conclusions <p>This study demonstrates that the Lahey modification is a safe technique for gender-affirming top surgery for patients with a wide range of breast sizes and ptosis. Our results exhibit high rates of retained nipple sensation and piloerection, with satisfactory aesthetic outcomes.</p> Level of Evidence III <p> This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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The Lahey Modification for Masculinizing Top Surgery: A Safe and Effective Technique to Preserve a Sensate Nipple

  • 期刊论文

  • 发表日期：

    2026年7月31日

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  • Natalie Kuhn,
  • Madeleine R. Gonte,
  • Quynh Anh Phan,
  • Gary Dong,
  • Miguel I. Dorante,
  • Lifei Guo

摘要

Background

Masculinizing top surgery is the most prevalent gender-affirming procedure offered to transgender and gender diverse individuals, most commonly via gender-affirming mastectomy and free nipple grafting. Our institution presents a novel technique for gender-affirming top surgery, adapted from the modified Robertson technique for reduction mammoplasty. Our approach preserves a sensate and dynamic nipple using an inferiorly-based, bell curve pedicle.

Methods

A retrospective chart review was conducted including all patients who underwent the Lahey modification technique for gender-affirming top surgery by a single surgeon at an academic hospital in Massachusetts from October 2018 to November 2024. Patient characteristics, intra-operative data, and clinical outcomes were analyzed utilizing descriptive statistics and univariate logistic regression. Outcomes were stratified by resection weight greater or less than the mean (x̄ = 571.5 g) to inform patient selection.

Results

Thirty-eight patients (72 nipples) were included in this study. The median length of follow-up was 5 months (range 1 week–60 months). In total, there was partial necrosis of seven nipples (9.7%), decreased sensation in seven nipples (9.7%), and complete loss of sensation in one nipple (1.4%). None of the patients experienced complete nipple loss. There was an overall high rate of subjective patient satisfaction.

Conclusions

This study demonstrates that the Lahey modification is a safe technique for gender-affirming top surgery for patients with a wide range of breast sizes and ptosis. Our results exhibit high rates of retained nipple sensation and piloerection, with satisfactory aesthetic outcomes.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.