After Having a Breast Reduction, What Are the Visual, Not Physical Differences in Having a Free Naple Graft Vs Not Having One?

Breast Reduction

Doctor Answers 14

Difference between free nipple graft and a regular reduction?

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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.

Baton Rouge Plastic Surgeon
4.9 out of 5 stars 93 reviews

Appearance of Free Nipple Graft Breast Reduction depends on the patient's skin type

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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.  

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 59 reviews

Visual and Physical Differences with Free Nipple Graft Technique

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Free Nipple Graft is only required in reduction of massively enlarged breasts. It results in inability to breast feed, loss of sensation, loss of nipple projection, inability to respond to touch and cold,incomplete take of the nipple/areolar graft and other complications can occur with this procedure. In my practice this is a very unusual as even very large breasts can be reduced with other techniques. On the other hand this is a technique that should be considered when it is expected that there is not sufficient blood supply for the nipple and areola survival in extreme cases.

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Free Nipple Graft Breast Reduction Differences

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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. 

Patrick C. Wilson, MD
Huntsville Plastic Surgeon

Free Nipple Graft Visual Differences

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   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

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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

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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.

Jeffrey Thaxton, MD
Charleston Plastic Surgeon

Free nipple graft is a problem for breast reduction

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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.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Free Nipple Graft In Breast Reduction

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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.

John Whitt, MD (retired)
Louisville Plastic Surgeon


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 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

Gary R. Culbertson, MD
Columbia Plastic Surgeon

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.