Do I have to remove and reattach the areola and nipple in breast reduction? Or does it just depend?

Doctor Answers 6

Breast Reduction Technique

Also known as reduction mammoplasty, #BreastReduction is an operation intended to reduce the size of a woman’s #breasts and improve their shape and position. Frequently, the areola (dark skin around the nipple) is also made smaller. Functional symptoms (medical problems) caused by excessive breast weight may be relieved or improved by this operation.

I prefer to use a minimal incision surgery with a “#vertical” or “#lollipopBreastReduction scar technique. This method has been used in Europe and South America for more than 30 years but is performed by a small number of Plastic Surgeons in this country.The trend toward using this much better procedure is growing as younger plastic surgeons learn this technique in their residency programs.The benefits include: approximately fifty percent less scarring, a narrower breast, better forward projection and shape, longer lasting improvement, shorter surgery time and less complications. In general, we have stopped using the older traditional “anchor” or inverted “T” incisions as these provide inferior results.

Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Free nipple grafting

 In regards to your question if the nipple and areolar have to be removed, it depends on your physical examination. If the breast are very long pendulous/droopy, there may be consideration for removal of the nipple and replacement of the nipple after the breast reduction. This is called a free nipple graft. Your plastic surgeon will determine if that is a necessary procedure. Personally, I do not like the procedure and perform a  procedure to re-creates a nipple-areola during a breast reduction surgery on a candidate who would otherwise get a free nipple graft 

Do I have to remove and reattach the areola and nipple in breast reduction?

Thank you for your question. In my practice, I've performed many breast reductions on some incredibly large breasts and I've never had to do a free nipple graft luckily. It's an option for very large breasts but I personally would not like to jump to it first; only if there's an issue with blood supply. Be sure to consult with several different board certified plastic surgeons to get a better idea on your prospects. Good luck!

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 19 reviews

Breast reduction

Free nipple graft  with today's techniques would be most unusual. It's something that would be reserved for truly giant size reduction. Make sure you speaking to a board-certified plastic surgeon and I would be surprised if this is suggested.  Good luck with your research. 

Sherwood Baxt, MD
Paramus Plastic Surgeon
3.8 out of 5 stars 25 reviews

Do I have to remove and reattach the areola and nipple in breast reduction?

Thank you for the question. The vast majority of breast reduction procedures are done without the need to completely detach the nipple/areola complexes.  Occasionally, if a very large breast reduction is planned ( with a long distance "move" planned for the nipple/areola complexes), free nipple grafting may be necessary.  Your best bet: seek consultation with board-certified plastic surgeons who can demonstrate significant experience helping patients achieve the types of outcomes you will be pleased with.  I hope this, and the attached link (dedicated to breast reduction surgery concerns), helps. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

It depends

Dear CJ,

In most cases, the nipple areola complex can be and should be saved. Only when the blood supply to the nipple is in question, for example, in diabetic patients, smokers, and women with very large and sagging breasts, does the free nipple graft come into play. Of course, in any patient, if the nipple and areola appears to have a poor blood supply intraoperatively, the graft may be necessary. I really hope this helps.


Jonathan Zelken, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 15 reviews

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