A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy
Background:. For transmasculine individuals, double-incision mastectomy with free nipple grafts is the most common procedure for gender-affirming chest masculinization. However, patients report decreased sensation postoperatively. Direct coaptation of intercostal nerves to the nipple–areolar complex...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2024-02-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005605 |
| _version_ | 1797292781455015936 |
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| author | Rishub K. Das, BA Katya Remy, MD Justin C. McCarty, DO, MPH Ian L. Valerio, MD, MS, MBA William G. Austen, Jr, MD Katherine H. Carruthers, MD, MS |
| author_facet | Rishub K. Das, BA Katya Remy, MD Justin C. McCarty, DO, MPH Ian L. Valerio, MD, MS, MBA William G. Austen, Jr, MD Katherine H. Carruthers, MD, MS |
| author_sort | Rishub K. Das, BA |
| collection | DOAJ |
| description | Background:. For transmasculine individuals, double-incision mastectomy with free nipple grafts is the most common procedure for gender-affirming chest masculinization. However, patients report decreased sensation postoperatively. Direct coaptation of intercostal nerves to the nipple–areolar complex (NAC) is an experimental technique that may preserve postoperative sensation, yet whether reimbursements and billing codes incentivize hospital systems and surgeons to offer this procedure lacks clarity.
Methods:. A retrospective cross-sectional analysis of fiscal year 2023 Medicare physician fee schedule values was performed for neurotization procedures employing Current Procedural Terminology codes specified by prior studies for neurotization of the NAC. Additionally, operative times for gender-affirming mastectomy at a single center were examined to compare efficiency between procedures with and without neurotization included.
Results:. A total of 29 encounters were included in the study, with 11 (37.9%) receiving neurotization. The mean operating time was 100.3 minutes (95% CI, 89.2–111.5) without neurotization and 154.2 minutes (95% CI, 139.9–168.4) with neurotization. In 2023, the average work relative value units (wRVUs) for neurotization procedures was 13.38. Efficiency for gender-affirming mastectomy was 0.23 wRVUs per minute without neurotization and 0.24 wRVUs per minute with neurotization, yielding a difference of 0.01 wRVUs per minute.
Conclusions:. Neurotization of the NAC during double-incision mastectomy with free nipple grafts is an experimental technique that may improve patient sensation after surgery. Current reimbursement policy appropriately values the additional operative time associated with neurotization relative to gender-affirming mastectomy alone. |
| first_indexed | 2024-03-07T20:02:34Z |
| format | Article |
| id | doaj.art-d846ad40c1d9494c88b13dafe253cb4a |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-03-07T20:02:34Z |
| publishDate | 2024-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-d846ad40c1d9494c88b13dafe253cb4a2024-02-28T06:48:00ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742024-02-01122e560510.1097/GOX.0000000000005605202402000-00039A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming MastectomyRishub K. Das, BA0Katya Remy, MD1Justin C. McCarty, DO, MPH2Ian L. Valerio, MD, MS, MBA3William G. Austen, Jr, MD4Katherine H. Carruthers, MD, MS5From * Division of Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, Nashville, Tenn.† Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.† Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.† Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.† Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.† Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.Background:. For transmasculine individuals, double-incision mastectomy with free nipple grafts is the most common procedure for gender-affirming chest masculinization. However, patients report decreased sensation postoperatively. Direct coaptation of intercostal nerves to the nipple–areolar complex (NAC) is an experimental technique that may preserve postoperative sensation, yet whether reimbursements and billing codes incentivize hospital systems and surgeons to offer this procedure lacks clarity. Methods:. A retrospective cross-sectional analysis of fiscal year 2023 Medicare physician fee schedule values was performed for neurotization procedures employing Current Procedural Terminology codes specified by prior studies for neurotization of the NAC. Additionally, operative times for gender-affirming mastectomy at a single center were examined to compare efficiency between procedures with and without neurotization included. Results:. A total of 29 encounters were included in the study, with 11 (37.9%) receiving neurotization. The mean operating time was 100.3 minutes (95% CI, 89.2–111.5) without neurotization and 154.2 minutes (95% CI, 139.9–168.4) with neurotization. In 2023, the average work relative value units (wRVUs) for neurotization procedures was 13.38. Efficiency for gender-affirming mastectomy was 0.23 wRVUs per minute without neurotization and 0.24 wRVUs per minute with neurotization, yielding a difference of 0.01 wRVUs per minute. Conclusions:. Neurotization of the NAC during double-incision mastectomy with free nipple grafts is an experimental technique that may improve patient sensation after surgery. Current reimbursement policy appropriately values the additional operative time associated with neurotization relative to gender-affirming mastectomy alone.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005605 |
| spellingShingle | Rishub K. Das, BA Katya Remy, MD Justin C. McCarty, DO, MPH Ian L. Valerio, MD, MS, MBA William G. Austen, Jr, MD Katherine H. Carruthers, MD, MS A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy Plastic and Reconstructive Surgery, Global Open |
| title | A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy |
| title_full | A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy |
| title_fullStr | A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy |
| title_full_unstemmed | A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy |
| title_short | A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy |
| title_sort | relative value unit based model for targeted nipple areola complex neurotization in gender affirming mastectomy |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005605 |
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