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Early Experiences With the Buttonhole Modification of the Double-Incision Technique for Gender-Affirming Mastectomies

Rothenberg, Kara A., MD*; Tong, Winnie M. Y., MD; Yokoo, Karen M., MD

doi: 10.1097/SAP.0000000000001617
Breast Surgery

Background Little has been published about transmasculine and nonbinary gender-affirming mastectomies, particularly for patients with skin excess who desire reliable vascularity and sensation to the nipple-areolar complex. In this case series, we describe our experiences with the “buttonhole technique.”

Methods This was a retrospective case series of all consecutive patients who had a buttonhole mastectomy by a single surgeon. This technique maintains the nipple-areolar complex on a dermal pedicle rather than using a free nipple graft.

Results Seventeen patients were included, with ages ranging from 21 to 49 years (median, 28 years). There were no major complications. Four patients had minor complications and/or required revision.

Conclusions The buttonhole technique should be considered for transmasculine and nonbinary patients with skin excess who are concerned about nipple vascularity and sensation.

From the *Department of Surgery, University of California at San Francisco–East Bay, Oakland;

Department of Plastic Surgery, Kaiser Permanente Medical Center, San Francisco; and

Department of Plastic Surgery, Kaiser Permanente Medical Center, Richmond, CA.

Received May 21, 2018, and accepted for publication, after revision July 16, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Kara A. Rothenberg, MD, S-SPIRE Center, Department of Surgery, Stanford University, 1070 Arastradero Rd, Suite 230–MC 5552, Stanford, CA 94305. E-mail:

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