Topical Nitropaste Reduces Partial Free Nipple Graft Loss in Gender Affirming Mastectomy: A Randomized Controlled Trial.

Abstract

Topical nitroglycerin has been shown to enhance wound healing and reduce flap necrosis after oncologic mastectomy.1,2 However, its impact on gender-affirming mastectomy outcomes, particularly in free nipple grafts (FNG), has not been well studied. This study aims to evaluate the effectiveness of topical nitroglycerin in patients undergoing double incision mastectomy with FNG (DIFNG), focusing on graft and wound-related outcomes. Adult patients undergoing DIFNG between August 2022 and June 2024 at a tertiary hospital were randomized into control (bacitracin) and treatment (topical nitroglycerin, 15mg per side) groups. All procedures followed a standardized surgical technique and perioperative regimen. Outcomes, including partial and total graft loss and wound complications, were assessed during routine bolster removal and post op visits. Ordinal logistic regression controlled for smoking status. Of 111 patients (56 control, 55 treatment), there were no significant differences in demographics or preoperative factors. The partial graft loss rate was significantly lower in the treatment group (18.2 % vs. 36.6 %, p = 0.004). Post-operative complications including seroma, hematoma, and wound complicate rates were not significantly different between the two groups. Rates of nipple graft hypopigmentation were significantly higher for African American patients compared to that of the Caucasian patients, but not significantly different between the control and treatment groups. Topical nitroglycerin application in DIFNG significantly reduces partial nipple graft loss without affecting wound complications.ClinicalTrials.gov Registry: NCT06428669.