![]() I tell patients that with my technique they should lightly scratch their upper chest with their fingernail before surgery – that is the sensation level the nipples will have in 90% of patients after surgery.ĭr. When a surgeon removes the entire layer of skin (leaving only fat beneath) the sensation would presumably be much poorer. It is not well known how many of the mechanoreceptors which come along with the graft actually help with sensation. Therefore some of the deep skin sensation end units ( pacinian corpuscles) will still be there beneath the graft, as will other mechanoreceptors. I do a partial skin removal, not complete, for skin graft recipient sites. Scott Mosser, a board-certified Surgeon who specializes in Top Surgery, shared his perspective: While it's encouraging to know that retaining very good nipple sensation is possible with DI, it's unclear if the sensation that's reported is in the nipple or actually under it. (Double Incision with free nipple grafting was performed in 62 breasts or 17.9%.) In a German study published in 2014, nipple sensitivity was rated as "very good" or "good" in 80.3% of the breasts. This severs the nerves that go into the nipple-areola, and as they are not microsurgically reconnected there is a substantial likelihood for loss of sensation in the nipples and areola.ĭespite this, many trans men who have had Double Incision report very good sensation, including erogenous sensation. With this surgery, the nipple-areolar complex (NAC) is completely removed and grafted on in a higher position on the chest. The most common type of Top Surgery is the Double Incision (DI) method. Choosing a Top Surgery Procedure That Retains Sensation The amount and type of sensation that can be lost is partly dependent on the type of Top Surgery procedure performed. This can affect blood flow to the nerves, resulting in some loss of sensation. While there is some variation person-to-person with regards to the exact path of the nerves, they generally pass through the fascia covering the pectoral muscles to reach the surface of the skin.Īll Top Surgery procedures all have one common characteristic: the removal of breast tissue underneath the nipple. Breast tissue has a rich network of sensory nerves, supplied mainly by branches of the 4th through 6th intercostal nerves. To understand how Top Surgery impacts sensation, it's also important to know a bit about breast anatomy. Erogenous sensation - This is the type of sensation that generates sexual response.Pain sensation - The sensation of acute discomfort.Temperature sensation - Also called thermosensation, this is the sensation of warm and cold.Tactile sensation - Also called touch sensation, this is the sensation produced by pressure receptors in the skin.Scott Mosser.įirst, it's important to define the different types of sensation: Learn more about sensation, breast anatomy and what kind of sensation to expect after Top Surgery in this first-of-its-kind primer featuring expert commentary by Dr. Academic studies on Top Surgery are primarily focused on visual results and complication rates, leaving the topic of sensation to the realm of anecdotal reports on the Internet. Retaining sensation is very important to many trans men considering Top Surgery but little has been written on the subject. Top Surgery and Sensation Concerned about loss of sensation after Top Surgery, or just wondering about how your new chest will feel? Minimal Scar Ideal for small chested men with excellent skin elasticity.Peri-Areolar Ideal for small chested men, or those with B-sized chests and good skin elasticity.Inverted-T Ideal for medium to large chested men who wish to retain more sensation in the nipple and areola.Double Incision Ideal for medium to large chested men.Buttonhole Ideal for medium to large chested men who prioritize nipple-areola size, positioning, sensation and pigmentation.
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