Introduction: Topical nitroglycerin has been shown to improve wound healing after oncologic mastectomy. Its impact after gender affirming mastectomy, however, has not been evaluated. The purpose of this study is to investigate the effectiveness of topical nitroglycerin in reducing rates of free nipple graft loss in patients undergoing gender affirming chest masculinization.
Methods: Patients undergoing double incision mastectomy with free nipple grafts were randomized into a control and treatment group. The treatment group had a one-time intra-operative application of topical nitroglycerin to the mastectomy skin around the free nipple graft. They were evaluated at 5 days, 2 weeks, and 6 weeks post-operatively for graft loss and characterized as no loss, unilateral partial loss, bilateral partial loss, or full graft loss. An ordinal logistic regression, controlling for smoking status, was performed.
Results: The study had a total of 93 patients with 46 patients in the control group and 47 patients in the treatment group. The two groups were equivalent in terms of age, race, ethnicity, comorbidities, ptosis, hormone therapy and chest binding. Overall, partial nipple graft loss rate was 36.6%, with no total graft loss observed. Controlling for smoking status, incidence of partial graft loss was significantly lower in the topical nitroglycerin group compared to the control group (21.3% vs. 52.2%, p = 0.00481).
Conclusions: One-time application of topical nitroglycerin around free nipple graft sites in double incision gender affirming mastectomy is associated with a significant decrease in partial nipple graft loss, mirroring the positive impact in oncologic mastectomy.