Maintaining Nipple Sensation

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The Denver-area FTM Top Surgery method developed by double-board certified Denver plastic surgeon Dr. Steinwald is a variation of the “tried-and-true”, widely practiced Inferior Pedicle/Wise-Pattern approach to breast reduction. This is designed to keep the nipple attached to its natural blood/nerve supply, and therefore preserve nipple-areolar complex viability and sensation as best possible. The “trade-off” is an anchor-shaped (or “inverted-T”) scar, the horizontal portion of which runs along the natural lower breast fold (although this is made straighter), and which occasionally extends into the underarm area, depending on fullness there. The vertical scar (if necessary) is usually very short, no more than 3-4 cm.

Dr. Steinwald has pioneered the use of the “ultrathin” inferior pedicle, applied to Wise-pattern incision/closure techniques for this method of chest masculinization, by which the nipple in most cases can remain attached, and retain a degree of sensitivity that is just not possible with free nipple grafting (FNG). “FNG” (often referred to as “double incision” although this is a bit of a misnomer) chest recontouring, aside from denervating the nipple-areolar complex (by definition), is also fraught with nipple malposition issues, unpredictable healing and scarring, often with thickening of the nipples or frank discoloration, especially in darker skin types. Conversely, with this inferior pedicle/anchor-incision closure technique, the nipple can be more predictably located, and heals much more naturally, again with at least partial, if not near-complete sensation preserved; this is possible in a great majority (90+%) of patients.