Hi there-
One of the primary considerations in breast reduction surgery is maintenance of the blood flow to the remaining breast tissue and nipple. With greater tissue removal, there is a greater risk of losing blood supply and therefore losing the remaining breast tissue and nipple to necrosis. The alternative of removing the nipple and replacing it as a free skin graft at the conclusion of the procedure exists, but I would never recommend this to a young woman, as all nipple sensation and function would be lost.
I think that it would be much better to reduce her breasts to a size which provides both the symptomatic improvement she desires, while maintaining a feminine and natural appearance. The only thing worse than breasts which are too large, would be to end up with breasts which are too small and the need to place implants later (!).
