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Proper nipple placement is important to achieving the male appearing chest. Also important is nipple/areolar proportion to the chest size and structure. Several factors are considered when determining a suitable position for placement of the areolar grafts in the chest reconstruction procedure. One factor that may be neglected is the skeletal structure of the thorax; in the male the rib cage is usually broader than in the female. This may occasionally make nipple position appear more lateral or to the outside at first glance. It is important, however, to avoid placing the areolar grafts too central. This gives a very unnatural appearance to the chest and stands out considerably. Nipple/areolar location is, in part, determined by the rib interspace, usually between the fourth and fifth intercostal spaces. The patient's height is taken into consideration. It is also established by measurement from the midline at this level, usually between 9.5cm and 11.0 cm. This number may vary from these parameters in the unusually large or small rib cage and chest. A suture is placed at the sternal notch in the midline of the neck at its juncture with the chest. This suture is used as a plumb line to swing from side to side to insure symmetry of the nipple/areolar grafts. The areolar size and shape are determined by the patient's overall chest size. It has been found that a variation of "nickel" size works in most instances. The patient's own desires are always taken into consideration as some might wish a larger or smaller structure. Understand that in the genetic male 90 % of areola are oval; only 7 to 10 percent are round. Areolar grafts tend to decrease in size with healing as the surrounding scar normally contracts. This is anticipated in determining graft size. These parameters are guidelines and each case is individualized based upon variations in chest size and structure, and patient input. |