After massive weight loss, male breasts in particular are one of the most disturbing body regions and can be a difficult area to treat often requiring nipple-areola repositioning. The need for bilateral repositioning of the nipple-areola complex is also increasing in other surgical fields such as in female-to-male transsexual patients with large breasts and in patients with severe forms of gynecomastia. Proper configuration and localization of the nipple-areola complex requires both meticulous planning and a thorough understanding of the male anatomy and is essential in determining final aesthetic outcome. Currently available guidelines create areolas that are too large, place the nipple-areola complex too high and too far medially, and/or require complex abstract mathematical calculations. Relying on the recently appreciated aesthetic value of the golden number Phi (ϕ) we propose an easy and reliable method to determine the horizontal and vertical coordinates of the male nipples. With only 2 easily measurable distances, umbilicus-anterior axillary fold apex and umbilicus-suprasternal notch, the internipple distance and the position of the horizontal nipple plane relative to the suprasternal notch can be calculated. The internipple distance can be determined with 95% accuracy and the distance from the suprasternal notch can be determined in 80% of cases within a range of 3.33 ± 1.25 cm.
From the *Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon; and Departments of †Surgery and ‡Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Received August 29, 2008, and accepted for publication, after revision, November 14, 2008.
The study was not financially supported by any organization or research board.
Reprints: Bishara S. Atiyeh, MD, FACS, Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon. E-mail: email@example.com.