Topical Nitropaste Reduces Partial Free Nipple Graft Loss in Gender-Affirming Mastectomy: A Randomized Controlled Trial.
Rachel H Park, Jessica Pawly, Graham Grogan et al.
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In 30 seconds
This randomized controlled trial evaluated topical nitroglycerin during double-incision mastectomy with free nipple grafts in adults at a tertiary hospital. Patients received bacitracin or topical nitroglycerin (15 mg per side), with graft and wound outcomes assessed postoperatively. Among 111 patients, partial graft loss was lower with nitroglycerin than with control (18.2% versus 36.6%; P = 0.004). Rates of seroma, hematoma, and other wound complications did not differ significantly between groups. Nipple graft hypopigmentation was more frequent among Black than White patients, with no significant difference by treatment group.
Key findings
- Partial nipple graft loss occurred in 18.2% with nitroglycerin versus 36.6% with bacitracin (P = 0.004).
- Seroma, hematoma, and wound complication rates did not differ significantly between treatment groups.
- Hypopigmentation rates were higher among Black than White patients, but did not differ significantly by treatment group.
Why it matters
Free nipple graft loss is a relevant outcome after gender-affirming mastectomy. In this randomized trial, topical nitroglycerin was associated with a lower rate of partial graft loss, while measured wound complications were not significantly different. These findings add trial evidence about a perioperative approach in this population, while the absence of a demonstrated effect on other complications is also important when interpreting the result.