Is a free nipple graft necessary?

I've had big breasts all my life and don't want to be a D or DD so I understand that a free nipple graft would be necessary and I don't really care about having sensation in my nipples or breastfeeding right now. I'd rather have small size B breasts as I would like to be more active..

Doctor Answers 10

Free graft

If I understand correctly, your surgeon told you that if you don't have a free nipple graft, your breasts can only be reduced to a D or DD cup size rather than the B cup size you desire.  I know that you can't answer me if that is correct but I will answer as if that is the case.

With that assumption, you must have very large breasts if your surgeon thinks DD would be your size after the reduction.

First consider rather you really want to be a B cup.  I find that many women who have always been large have a hard time going to that size.  I have had a few patients who returned a few years after a reduction and requested to have implants placed.  They didn't want to return to their previous sizes of DDD or more.  But they did want to get up to a full C cup or even a D cup again.  For many women, this is a part of their identity that is hard to change. 

If you decide that you really want to be a B cup and you are currently VERY large, then a free nipple graft may be appropriate.  I have done this only about 3 times in nearly 30 years of practice.  I believe it was appropriate in all of these cases because of the potential for loss of the nipple/areolar complex if we had tried to maintain it on a very long base.  You can get a rough idea of the risk by measuring from the sternal notch (the top of your breast bone at the base of your neck) to the nipple.  If this over 40 cm (about 16"), I start to think about free nipple grafting.  That does not mean that I always recommend a free graft if this measurement is over 40 cm, I just consider it and assess other characteristics of the breasts before making a recommendation.

This is always a difficult decision and one that does not always have a correct answer.  I recommend that you talk with your surgeon again before deciding.  If you are not content with that conversation, consider getting a second opinion.

Good luck to you.  Breast reduction patients tend to be very glad they made the choice to have this procedure.

Pensacola Plastic Surgeon
4.9 out of 5 stars 10 reviews

Breast Reduction - Free Nipple Graft?

Without photos it is not possible to give you an exact answer but I have not found it necessary to perform free nipple grafts for a breast reduction in the last 15 years. I suspect that if you are only a D or DD that it is highly unlikely in your case that a free nipple graft would be necessary. Please consult with a Board Certified Plastic Surgeon.

Seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well.

Alexander G. Nein, MD, MS, FACS
Nashville Plastic Surgeon
4.4 out of 5 stars 25 reviews

Breast reduction and free nipple grafting

Thank you for your question.

My take is that you are a D-DD now and want to be a B cup.

In my experience, free nipple grafting is not needed very often with breast reduction surgery. Without photos I can not say for sure in your case but plastic surgeons have several techniques to preserve nipple blood flow in this type of surgery.

If you were advised you need a free nipple graft with your breast reduction you may want to get a second opinion to make sure you are one of the rare people who need that.

Free nipple graft with breast reduction

I have used a free nipple graft exactly once in my 14 years of practice.  It's just not necessary, in the vast majority of cases.  Of course, there are always exceptions, so have a consultation with a couple of board-certified plastic surgeons to get their opinions in your specific case.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 38 reviews

Is a free nipple graft necessary?

Free nipple grafts with breast reduction are very rarely needed. See an experienced plastic surgeon for an evaluation.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 63 reviews

Is a free nipple graft necessary?

This issue comes up from time to time and we realise that some surgeons do use free nipple grafting during breast reduction. We have performed hundreds of reductions, some very large and never have used a free nipple graft or found it to be necessary. The trouble with the nipple as a graft is loss of sensation, loss of color, loss of cold response, and no lactation. This is quite a trade off.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 39 reviews

Impossible to give you an answer

We would need to see pictures and have measurements taken to give you the most qualified answer.  In general though, the larger you are now and the smaller you want to go will increase your chances that a breast reduction with free nipple grafts would be necessary to get you the best results.  I rarely have to do them, but in a select population of patients, it is the best and safest option.  Hope this helps.


Is a free nipple graft necessary?

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.

Free nipple grafts and breast reduction

Free nipple grafts are not an absolute with breast reduction surgery.  The need for free nipple grafting depends on your starting anatomy.  Many patients with D/DD sized breasts are able to safely undergo a traditional breast reduction without requiring a free nipple graft.  Even a traditional breast reduction does still have a risk of affecting sensation or future breastfeeding, although it is much lower compared to free nipple grafting.

I would recommend scheduling a consultation with a board-certified plastic surgeon, who will be able to examine you, take measurements, discuss your goals and expectations, and determine whether you would need to have a free nipple graft for your breast reduction.

Hope this helps, and best of luck on your journey.
Dr. Lim

Angeline Lim, MD
Palo Alto Plastic Surgeon
5.0 out of 5 stars 10 reviews

Is a free nipple graft necessary?

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 always an option 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 14 reviews

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.