I have had several consults in the area, hearing from all of them that I would most likely need a free nipple graft. I'm 29 years old so this isn't particularly appealing. lol Wear 38I/J bras, would like to be 38D but would do 38DD if it would avoid FNG. Measurements: Notch to Nipple: 38L, 37R Fold to Nipple: 17L, 16R Est tissue removal: 1800-2000g per side Do you have any advice? Agreement? Disagreement? Thanks.
Should I Need a Free Nipple Graft for Breast Reduction?
Doctor Answers (14)
Free Nipple Grafting?
Thank you for the question.
Although I understand your concern about the downsides of free nipple grafting at your age, sometimes this is necessary to avoid serious complications after the breast reduction procedures performed. If several well experienced board-certified plastic surgeons have suggested this procedure then it is likely that it will be in your best interest IF you decide to proceed with the breast reduction procedure understanding the risks/complications/scarring/loss of sensation and inability to breast-feed etc.
I hope this helps.
Free nipple graft for breast reduction is uncommonly indicated.
Most reductions can be done safely without a free nipple graft. In older patients where the nipple and areloa need to be transferred several inches, jeopardy to the viability of the areola might make a free nipple graft necessary. In my practice, this is only occasionally done (less than 1 in 50 cases).
Breast reduction without free nipple graft
Breast reduction can be done safely without a free nipple graft. I feel the technique is past its time. The grafted nipple will lose sensation, texture, and even lose some of the color and we have better solutions to preserve the nipple circulation, even with very large breast reductions. My advice would be to keep looking.
Best of luck,
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Breast Reduction with Free Nipple Graft
In general, the only patients on whom I perform breast reduction with free nipple graft are those who have undergone previous breast reductions. In these patients, the blood supply to the nipple is inconsistent and highly dependent on the technique used for breast reduction by the previous surgeon.
Otherwise, breast reduction with free nipple grafts is unnecessary. In cases where a large volume reduction is being performed for breasts with high nipple to fold distances (>17cm) I will reserve the option to perform free nipple grafts at the end of the procedure. If the blood supply to the nipple is questionable after performing the breast reduction technique, I will "convert" to a free nipple graft to avoid loss of the nipple (nipple necrosis). This is an extraordinarily low likelihood and I have encountered this only once in my career. In the vast majority of cases, a pedicled breast reduction provides satisfactory blood flow to the nipple areolar complex.
Free nipple grafting in breast reduction
In my practice, I rarely perform free nipple grafting for breast reduction. With free nipple graft, you will not have sensation to your nipples and will lose pigmetation on your areolas. In rare circumstances when we suspect blood supply to nipple-areolar complex is compromised, we perform free nipple grafting in order to avoid nipples "dying" after surgery. Given your measurement, I do think conventional breast reduction (without free nipple graft) can be performed safely.
Free nipple graft with breast reduction
Hard to tell with out photos or an exam. Free nipple grafts are rare these days. Most can be addressed with moving the nipple areola complex on a pedal of tissue. Good to see several board certified plastic surgeons. Also would ask if they do many of these, and are they experienced with large reductions. Ask to see before and after photos. Also a good idea to bring in photos that you like. Together you will be able to make an informed decision.
Free nipple graft
You are a bit on the large side for an inferior pedicle reduction but it can be done successfully. There are few women who absolutely "need" a free nipple graft technique these days
John Di Saia MD
Breast Reduction without Free Nipple Graft
Yes, your surgery can be done without the free nipple graft. There are two parts to breast reduction surgery, the skin part and the pedicle. The pedicle is the tissue that remains after the excess is removed. It is the tissue that the nipple areolar complex gets its blood supply from.
The predominant breast reduction method used by plastic surgeons is the "inferior pedicle" method. In this procedure breast tissue is removed from the inferomedial, superior and inferolateral breast. The remaing tissue is 10-12cm wide, starts at the fold and extends superiorly to just above the nipple areolar complex. The biggest problem is that this pedicle has limited blood supply so a large reduction, such as yours, is impossible as the nipple would necrose.
I use the superomedial pedicle technique. In this procedure the breast tissue that bothers women the most is removed. This is all of the inferior and lateral tissue. The shape will still be the same and I argue better because the superior tissue is not removed. But the biggest advantage is the blood supply. The superomedial pedicle gets blood supply from each rib and vessels that come from the collarbone. It has such good blood supply that I have never worried about losing a nipple.
So look in your area for a surgeon that uses this technique and you will be rewarded.
Is Free Nipple Graft necessary?
I could not answer this question without seeing photos and examining you. I will only use nipple grafting technique about 2% of the time, but sometimes it may be necessary depending on a number of factors to prevent nipple or areolar wound healing problems or necrosis (skin death) . If several doctors have suggested that this would be the best procedure for you, it may be the case. If you don't ,you may have to accept the possibility of losing your nipple altogether.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.