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Nipple-Preserving Inferior-Ellipse Mastectomy

Nipple-Preserving Inferior-Ellipse Mastectomy
Nipple-Preserving Inferior-Ellipse Mastectomy

A Next-Generation Top Surgery for Natural Contours and Subtle Scars

The Nipple-Preserving Inferior-Ellipse Mastectomy is an innovative top surgery technique developed by Dr. Rachel Bluebond-Langner, a board-certified plastic and reconstructive surgeon at NYU Langone Health in New York City. Designed to preserve the nipple-areola complex and achieve a natural chest contour with well-hidden scars, this technique is an important alternative for those who are less qualified for traditional approaches.

The two most common types of gender-affirming top surgery are the double incision with nipple grafts and the periareolar (around-the-nipple) approach. But not everyone is a good fit for these methods. Some people have nipples that sit high on the chest with extra breast tissue and loose skin. In these cases, the double incision method might leave scars too high on the chest, while the periareolar technique might not remove enough skin for a flat result.

For these patients, Dr. Bluebond-Langner’s nipple-preserving inferior-ellipse mastectomy can be a better option. This technique removes the extra tissue and skin while keeping the nipples in their natural position, with a scar that sits lower and is more easily hidden under the chest muscle line.

How It Works:

  • The nipple-areola complex (NAC) stays in place. It’s not removed and grafted, which preserves sensation and natural appearance.
  • The incision follows the shadow of the pectoral muscle. This helps hide scars and gives a masculine contour.
  • Extra breast tissue and skin are removed, especially from the lower and outer parts of the chest (including the area near the armpit).
  • Drains are placed temporarily to help with healing and prevent fluid buildup.
  • The incisions are closed in layers to support good healing and reduce scarring.
  • Nipple reduction can be performed as an in-office procedure under local anesthetic approximately nine months later, if desired.
Surgical Demonstration
Watch Dr. Rachel Bluebond-Langner perform the nipple-preserving inferior-ellipse mastectomy and see the surgical results in these two detailed academic videos. Please note: These videos contain graphic surgical content.

What to Expect After Surgery:

  • Masculine chest contour
  • Scars that sit low on the chest and follow the muscle line
  • Nipples are in a natural, slightly lower and outward position
  • NAC sensation preservation

Surgical Results: Effective and Low Complication Rates
In a review of 16 patients who had this surgery with Dr. Bluebond-Langner, most had good results. None lost their nipples, and only two needed small touch-up procedures. One patient developed a fluid buildup (called a seroma), but it went away with simple treatment. Overall, this method worked well for people with small to moderate-sized chests, extra skin on the lower part of the chest, minimal sagging and nipples positioned high on the chest wall.

Pros

  • Preserves NAC position and nerve supply.
  • No need for nipple grafts, reducing risks like depigmentation or graft loss.
  • Scar may be more discreet than traditional double incision scars.

Cons

  • Limited ability to reposition the NAC.
  • Not ideal for large-chested individuals.
  • Less ability to remove excess lower chest skin compared to the double incision method.

The Nipple-Preserving Inferior-Ellipse technique offers a natural-looking result for those who don’t quite fit the typical criteria for double incision or periareolar top surgery. Contact Dr. Bluebond-Langner to find out if this approach is right for you.

Dr. Rachel Bluebond-LangnerDr. Rachel Bluebond-Langner is a board-certified plastic and reconstructive surgeon specializing in gender-affirming surgeries at NYU Langone Health in New York City. As a leader in transgender surgical research and innovation, Dr. Bluebond-Langner actively develops and studies new techniques to optimize patient safety, outcomes, and satisfaction. Her work has introduced several novel procedures designed to better meet the needs of her patients.

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References
Robinson IS, Salibian A, Zhao LC, Bluebond-Langner R. Nipple-Preserving Inferior-Ellipse Mastectomy: A New Technique for Gender-Affirming Top Surgery. Plast Reconstr Surg. 2024 Aug;154(2):237e-240e.
This study introduces the nipple-preserving inferior-ellipse mastectomy technique, developed by Dr. Rachel Bluebond-Langner, and provides a detailed analysis of its outcomes.

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Last updated: 05/18/25

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