{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:07:42Z","timestamp":1784135262895,"version":"3.55.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100007914","name":"the University of Texas Southwestern Medical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007914","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,15]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Free nipple\u2013areola grafting (FNAG) is the most common approach for nipple\u2013areola complex (NAC) reconstruction in transgender patients and is often performed in conjunction with double-incision mastectomy for chest masculinization. Unwanted consequences of FNAG include graft failure, hypopigmentation, and circular scarring around the areola.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We developed a novel technique for NAC reconstruction with nipple punch grafts in conjunction with 3-dimensional (3D) areola tattooing (NPAT). Patient demographics and postoperative complications were reviewed. To compare aesthetic outcomes of NPAT with FNAG, postoperative images of both groups were distributed among public raters on the crowdsourcing platform Amazon MTurk. Raters were asked to rank the aesthetic appearance of each NAC on a 1 to 7 Likert scale.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Eighteen patients (mean age 30 \u00b1 10.74, mean BMI 27 \u00b1 7.36) underwent double-incision mastectomy together with NPAT for NAC reconstruction. Mean follow-up was 100\u2005days after surgery. Postoperative complications such as graft loss, partial graft necrosis, and hypertrophic or distended scarring were not observed. One patient demonstrated a loss of graft projection, and 1 patient developed partial graft depigmentation. Across the full sample of 895 public raters, NPAT received significantly higher aesthetic ratings than FNAG (NPAT 5.0 \u00b1 1.5 vs FNAG 4.5 \u00b1 1.8, P &lt; .001), a pattern that persisted across different genders and age groups.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The NPAT technique is a simple and effective approach to NAC reconstruction in transgender patients, combining the advantages of traditional FNAG and 3D tattooing. Our findings suggest that NPAT may provide an aesthetically superior NAC and potentially reduce complications associated with traditional FNAG.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence: 4 (Therapeutic)<\/jats:title>\n For image description, please refer to the figure legend and surrounding text.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/asj\/sjag087","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T11:38:25Z","timestamp":1776944305000},"page":"927-932","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Technique for Nipple\u2013Areola Reconstruction in Gender-Affirming Mastectomies With Nipple Punch Grafts and Areola Tattooing (NPAT)\u2014A Pilot Study"],"prefix":"10.1093","volume":"46","author":[{"given":"Bardia","family":"Amirlak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan","family":"Amini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhya","family":"Nadarajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Henn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"2026071512380468700_sjag087-B1","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1007\/s00266-019-01479-2","article-title":"Masculinizing chest reconstruction in transgender and nonbinary individuals: an analysis of epidemiology, surgical technique, and postoperative outcomes","volume":"43","author":"Cuccolo","year":"2019","journal-title":"Aesthetic Plast Surg"},{"key":"2026071512380468700_sjag087-B2","doi-asserted-by":"publisher","first-page":"612","DOI":"10.21037\/atm-20-4522","article-title":"Nipple\u2013areola complex reconstruction in transgender patients undergoing mastectomy with free nipple grafts: a systematic review of techniques and outcomes","volume":"9","author":"Bustos","year":"2021","journal-title":"Ann Transl Med"},{"key":"2026071512380468700_sjag087-B3","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003628","article-title":"Improved surgical outcome with double incision and free nipple graft in gender confirmation mastectomy","volume":"9","author":"Kamali","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026071512380468700_sjag087-B4","doi-asserted-by":"publisher","first-page":"14","DOI":"10.29252\/wjps.10.2.14","article-title":"Incidence of complications in chest wall masculinization for the obese female-to-male transgender population: a case series","volume":"10","author":"Perez-Alvarez","year":"2021","journal-title":"World J Plast Surg"},{"key":"2026071512380468700_sjag087-B5","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003792","article-title":"Double-sided nipple\u2013areola complex marker for masculinizing chest surgery","volume":"9","author":"Mundinger","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026071512380468700_sjag087-B6","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1007\/s00266-017-0935-7","article-title":"Creation of an aesthetic male nipple areolar complex in female-to-male transgender chest reconstruction","volume":"41","author":"Agarwal","year":"2017","journal-title":"Aesthetic Plast Surg"},{"key":"2026071512380468700_sjag087-B7","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004272","article-title":"The application of medical tattooing 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