Crowdsourcing the Ideal Nipple-Areolar Complex Position for Chest Masculinization Surgery

Abstract

Background: Chest masculinization surgery is increasing in prevalence. However, the ideal location of the nipple-areolar complex (NAC) is unknown. Our purpose was to determine the most aesthetically favorable male NAC position for use in chest masculinization through crowdsourcing. Methods: Using Adobe Photoshop CC 2017, 8 locations for the NAC were created based on previous literature descriptions. Amazon Mechanical Turk was utilized as a crowdsourcing interface—respondents were asked to rank the top 3 most favorable and least favorable images. Analysis of variance with subsequent Tukey HSD was used for a statistical comparison of favorability scores for different NAC localizations. Values were considered significant with P < 0.05. Results: Eight hundred nineteen respondents participated in the survey. NAC positions of Images C (mean score = 1.9222) and A (mean score = 1.7365) received higher favorability scores than those of Images D, E, F, G, and H (all P < 0.05). There were no significant differences between Images C and A (C versus A: P = 0.6412). NAC localizations from Images G (mean score = −2.0353) and H (mean score = −1.6908) received lower favorability scores than Images A, B, C, D, E, and F (all P < 0.05). There were no significant differences between Images G and H (P = 0.2279). Conclusions: Most respondents preferred Images C and A, and few favored Images G and H, suggesting that lateral NAC placement is favored over more medial localizations. Additionally, both Images C and A utilize relatively inferior NAC placements. Therefore, we recommend a location inferior and lateral to the NAC. Ultimately, NAC localization during chest masculinization will be the result of shared decision-making between the patient and the surgeon to fulfill each patient’s aesthetic goals.

Improved Surgical Outcome with Double Incision and Free Nipple Graft in Gender Confirmation Mastectomy

“…The NAC was then regrafted to its new position on the thorax with the use of the pectoralis muscle, clavicle, and sternum as landmarks. 7 , 16 , 17 …”

Crowdsourcing in Plastic & Reconstructive Surgery: A Systematic Review with Reporting Recommendations

“…Forty-five articles were ultimately included for data extraction (Table 1). 13–57 Proportionate rater agreement was 91.7% for abstract screening and 92.5% for full-text screening. The Cohen kappa coefficient for interrater reliability was 0.82 for abstract screening and 0.81 for full-text screening, demonstrating sufficient interrater reliability.…”

Development and Initial Validation of a Novel Professional Aesthetic Scale for the Female Abdomen

“…This is an acceptable shortcoming because previous studies that have used MTurk to ascertain aesthetic preferences have demonstrated that MTurk respondents are a diverse representation of the general population, with variations in gender, age, and country of origin in different studies. 8,31,32 Furthermore, although a general sample from MTurk was used to validate our aesthetic rating scale, it has previously been shown that gender, race or ethnicity, and age affect aesthetic preferences. Thus, we envision future studies that aim to validate this scale among specific clinical samples of patients who are seeking or have undergone abdominoplasty and that detailed demographic data could be collected and integrated into analyses of these data.…”