After Having a Breast Reduction, What Are the Visual, Not Physical Differences in Having a Free Naple Graft Vs Not Having One?
Doctor Answers 14
Difference between free nipple graft and a regular reduction?
The difference visually is loss of pigment and projection with a free nipple graft, the nipple also losses sensation in terms of physical symptoms and changes, I rarely perform them but sometimes they are neccesary for extremely large breasts.
Appearance of Free Nipple Graft Breast Reduction depends on the patient's skin type
BreastQuestion: As a resident in Texas we routinely used free nipple graft breast reduction techniques for patients who a) had gigantomastia, where the distance between the nipple and collar bone was greater than 32cm; b) required a shorter operative time because of their medical history. The results were generally very acceptable, with one caveat: when the nipple is taken off the breast as a full thickness skin graft and applied as a free nipple graft, it generally looses its pigment, becoming either deep pink for darker skin types or pale pink for lighter individuals. It was always preferable to disclose this to our African American patients, preop. Free Nipple Graft is always discussed as a "salvage" procedure, in the event that a nipple areolar complex looses its blood supply. Regrettably, FNG techniques usually eliminate all erogenous sensation.
Visual and Physical Differences with Free Nipple Graft Technique
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Free Nipple Graft Breast Reduction Differences
Free nipple graft breast reduction is sometimes necessary for extremely large reductions (3kg per side or more). The nipples can have decreased pigmentation that is particularly visible in an African American females. The hypopigmentation can be improved with post operative nipple tattooing. They also result in nipples that lack projection. I do everything possible to safely avoid requiring free nipple grafts in my breast reduction patients to avoid these undesirable outcomes.
Free Nipple Graft Visual Differences
Free nipple graft in the best of circumstances may have a little bit of pigment change, but most methods of breast reduction can usually account for tremendous size reduction without performing a free nipple graft.
Free nipple graft - don't do it
Hello and thanks for your question. I was originally trained in residency in performing free nipple grafts, but I have yet to actually do this in private practice as I never liked the results of it. It would take a very unique presentation for me to consider a free nipple graft as necessary. As a colleague of mine has stated, she would rather see it start to die then to take it off immediately! Removing the nipple comepletely from its blood supply turns the tissue into a full thickness skin graft. Normally these heal okay, but you will see discoloration sometimes from it. For example, an african american with resultant pink nipples and native dark breast skin is very unsightly, and can cause embarrassment for the patient. In addition the erectile function of the musculature in the nipple is gone, so it will also flatten out. The sensation is altered as whatever remaining nerves in the recipient site will have to try and grow in to the area. The "eroginous" sensation is for most part lost. Also as the milk ducts have been severed, breast feeding is not an option. I would discuss your breast reduction with a board certified plastic surgeon in order to further answer your questions. Good luck in your endeavors.
Robert Kratschmer, MD
Free nipple grafting
Free nipple grafting is almost never a needed technique in breast reduction surgery. With older patients with very large breasts it may be a good option but the lose of sensation, projection, pigmentation and the ability to lactate make it poor choice for most women seeking breast reduction. If a free nipple graft has been recommended to you I would consider getting another opinion prior to proceeding. Also I would suggest you ask to see before and after photos of patients with similar sized reductions to your planned reduction.
Free nipple graft is a problem for breast reduction
With current techniques for breast reduction, free nipple grafting is not necessary and will have side effects most will wish to avoid. Beside the loss of nipple sensation, the nipple is prone to lose color or pigmentation, and will also lose contractile function. Lactation after breast reduction can be significantly reduced, but for those who have had a nipple graft lactation is zero. Several more consults might be in your interest.
Free Nipple Graft In Breast Reduction
I prefer not to perform reductions using free nipple-areolar grafts in nonsmokers. In addition to a permanent loss of sensation, there can also be a loss of pigment especially in African-American patients.
With a Free Nipple Graft (FNG) there is often less projection of the nipple (flatter) and a longer healing interval as compared to a pediculed procedure. Because of the loss of nipple sensation many patients prefer not to undergo FNG Breast Reductions. Best,
Gary Culbertson, MD, FACS
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.