Abstract：
There is no consensus on the ideal scar location and inframammary fold (IMF) placement in the gender-affirming double-incision mastectomy technique. Recent advances in imaging technology have facilitated noninvasive investigations into anatomic variability, in many cases, obviating the traditional approach of cadaveric dissection to answer anatomic questions. A better understanding of chest wall sexual dimorphism may allow surgeons who perform gender-affirming procedures to achieve more natural-appearing results. A total of 60 chests were analyzed using either cadaveric dissection (n = 30) or virtual dissection with 3-dimensional (3-D) reconstructions of computed tomography (CT) images (n = 30) using the Vitrea® software. Chest proportions were recorded using each technique, correlating surface anatomy with muscular and bony landmarks. Cadaveric and 3-D radiography chest analysis revealed that natal male chest walls are, on average, wider and longer than natal female chest walls. The pectoralis major muscle dimensions and the location of its insertion were not found to significantly differ between male and female chests. The male nipple-areolar complex (NAC) tended to be narrower in length and width, with a less projecting nipple than the female NAC. Finally, the IMF was found to lie over the interspace between the fifth and sixth rib in both male and female chests. Our findings confirm natal male and female IMF are positioned between the 5th and 6th ribs. This fact affirms the senior author\'s technique of masculinizing the chest, keeping the masculinized IMF at approximately the same level as the natal female IMF and following the pectoralis major muscle edges to define the resulting scar in a way that differs from previously reported techniques.
摘要：
在确认性别的双切口乳房切除术技术中，理想的疤痕位置和乳房下褶皱（IMF）位置尚无共识。成像技术的最新进展促进了对解剖变异性的非侵入性研究，在许多情况下,避免用传统的尸体解剖方法来回答解剖问题。更好地了解胸壁性二态可能会使进行性别确认程序的外科医生获得更自然的结果。使用Vitrea®软件使用尸体解剖（n=30）或使用三维（3-D）重建计算机断层扫描（CT）图像的虚拟解剖（n=30）分析了总共60个胸部。使用每种技术记录胸部比例，与肌肉和骨骼标志相关的表面解剖学。尸体和三维X线胸片分析显示，出生男性胸壁，平均而言,比出生的女性胸壁宽和长。男性和女性胸部的胸大肌尺寸及其插入位置没有显着差异。男性乳头-乳晕复合体（NAC）的长度和宽度趋于较窄，乳头比女性NAC突出。最后,发现国际货币基金组织位于男性和女性胸部第五肋骨和第六肋骨之间的间隙上。我们的发现证实，出生时的男性和女性IMF位于第5和第6根肋骨之间。这一事实肯定了资深作者的胸部男性化技术，将男性化的IMF保持在与出生女性IMF大致相同的水平，并遵循胸大肌边缘，以不同于先前报道的技术的方式定义所产生的疤痕。
