Can I have a mastectomy w/ nipple grafting then either at that time or at a later time get a small B cup breast implant?

Good question. If you do not have breast cancer or are not at elevated risk for it with strong family history or genetic testing then I would strongly encourage you to go the route of breast reduction instead of mastectomies. If you are not averse to free nipple grafts as suggested in your question then you could more than likely get down to a small B cup as desired with a breast reduction. Implants can provide a great reconstruction or augmentation but I always caution all patients that they are "parts" and will therefore wear out and need to be replaced. At 24 that could mean several additional surgeries over your lifetime. Good Luck. 

One option to consider would be a free nipple graft technique breast reduction.  With the free nipple graft you don't have to worry about blood supply to the nipple and can make the breast much smaller with excellent control over the shape and size.  You would eliminate the need for implant reconstruction and the risk of capsular contracture or implant palpability, etc.

I appreciate your question.You can have either a reduction or mastectomy and reconstruction. Both of those have pluses and minuses i terms of recovery and outcomeGiven that you will need a nipple/areola graft, you might be able to reduce the size to why you want as we aren't limited on blood supply.The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

It is possible to do a reduction as a free nipple graft procedure and get a really small breast as a result. I would suggest you do that. You may need to have a psychologist or psychiatrist consult to confirm to your plastic surgeon that this is what you want. People present to plastic surgeons regularly asking for things that really aren't what is commonly considered appropriate. The surgeon may not want to take you if they think you'll be back complaining in a few years because the breasts are too small.

When gender 'non-conforning' and wanting a near flat chest, it can be accomplished with nipple grafts as you ask.  If you find an understanding surgeon, your insurance will cover the reduction as you will easily meet any minimums established by your insurance company.  And if your surgeon is really creative and good, you could have your implant placed at the same time as your reduction/mastectomy.  It would be preferable in my hands that you have your reduction first as you may not need an implant, depending on what your feelings are at that time.

Hi,

Thanks for posting your question. I am happy to try and help you. It is
important to remember that a board certified plastic surgeon will be your best
resource when it comes to an accurate assessment of your situation, and
concerns.

Having said that, you should go see your plastic surgeon. Online consultants
are not the appropriate source of information for you; your plastic surgeon
should be your resource when it comes to this type of difficult decisions.

Best wishes,

Dr. Michael J. Brown
Northern Virginia Plastic Surgeon

Thank you for your question and photos but an examination and open discussion of desired results is really needed to make a meaningful recommendation.  So see some experts in your areaDr Corbin

You don't need mastectomy surgery and implants, you would probably just need a free nipple graft reduction which can make you very small but better looking than the mastectomy/implant.