Is a free nipple graft (FNG) required? (Photo)

Thank you for your question.
Based on the photos you provided, it is very likely that you will require a free nipple graft with your breast reduction. Since the distance from your collar bone to your nipple is quite large, the blood supply to the nipple may be compromised during your surgery creating a risk of losing the nipple entirely. I would recommend speaking with your surgeon to discuss your concerns.

It is important to understand that the further the nipple needs to move during a breast reduction, the higher the risk of problems with blood supply. However, based on the photos you've shared it looks like you would be a candidate for a standard breast reduction without free nipple graft and aiming for a C or D cup would be reasonable. The amount of tissue removed has less bearing on blood supply to the nipple than how far the nipple has to move and other medical history (smoking etc)

No, you do not need a free nipple graft. The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.

Best Wishes,

Gary Horndeski, M.D.

You don’t need a free nipple graft. As far as size is concerned take a look at the surgeons photos of other reductions he or she has done. Avoid the temptation to go too small

Dear ditonoui,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for your question and for sharing your photos! This is a difficult question to answer without examining you in-person. A free nipple graft is generally performed when there is concern about the blood supply to the nipple. The indication for a free nipple graft can be impacted by several factors, such as how large your breasts are or how much breast tissue is being removed, or whether you have other risk factors (such as smoking). I try to avoid a free nipple graft if at all possible because it often results in a less aesthetically pleasing nipple, impaired nipple sensation, and inability to breast feed. Unfortunately, it is impossible to guarantee a specific cup size, as bra sizes are not standardized. There are many ways to perform a breast reduction. I perform breast reduction surgery under IV sedation in our fully-accredited operating room with board-certified anesthesiologists. It is important to speak with a fully-trained plastic surgeon to discuss all your options.

From your photos, I note you exhibit extremely large breasts with significant sag as well as areolar enlargement. You appear to represent a suitable candidate for breast reduction if you are in good medical health.Breast reduction can be performed with either a pedicle flap to maintain the viability of the nipple areolar complex, or by replacing the nipple areolar complex as a free graft. The pedicle flap which maintains the blood supply to the nipple-areolar complex must be at least of a certain thickness and less than a certain length to ensure nipple areolar tissue survival. The thickness of the flap will therefore compromise the amount of reduction you can achieve since if compressed too tightly by the closure, the tissue will not survive. A long flap may exceed its blood supply and the tissue will not survive.A free graft is necessary during breast reduction in patients who suffer from "gigantomastia", as otherwise adequate reduction cannot be accomplished (you appear to be in this category).Best wishes...