What notch to nipple distance would you say you must do a free nipple graft for a breast reduction?

Hello and thank you for your question. Although 37cm and 40cm are significant distances, committing a patient to an insensate free nipple graft in my practice is more an exception than the rule. I would recommend an in-person evaluation with another board certified plastic surgeon to obtain an additional perspective. Your first plastic surgeon is recommending a conservative, safe, approach and cannot be faulted. However, a second opinion is never a waste of time.

For more information on Breast Reduction, please refer to my link below.

Good luck.

Mark K Markarian, MD, MSPH, FACS
Harvard-trained Board Certified Aesthetic Plastic Surgeon

Free nipple grafting is at best a life boat that will turn the complex structure of your nipple areolar complex into a flattened, insensate patch. Instead plan a surgery that moves the nipple less than the optimal distance and preserve more breast tissue, this will reduce the risk of nipple necrosis. A second surgery can then be performed one to two years later that will allow more reduction and better nipple placement.

Rarely, if ever, are nipple grafts necessary. Distances of 37 and 40cm don’t require them, however, risks of nipple loss are higher. Experience, judgement, and honest discussion of these risks are paramount.

I don’t necessarily think that you need to be done with a free nipple graft. You might consider getting a second opinion.

Dear peachyy,
No need to worry about a free nipple graft when using the Bellesoma breast reduction technique. My patients never need one and do not require the dreaded and very visible vertical scar. Most of my patients either maintain nipple sensation or it increases by pulling the breast back where it belongs. You are welcome to visit my gallery to see several examples of the Bellesoma breast lift and breast reduction method. I hope this helps.
Best wishes and kind regards,

Hi Peachyy
In my experience it would be extremely likely that you would require a graft. Ultimately this is determined by your original size & your desired size plus your height and chest height, as well as your notch to nipple distance. However, 37 & 40cm are very low and I generally start considering a graft when the distance is more than 30cm. In terms of nipple sensation, it would be very unlikely to maintain sensation even if a pedicled technique was able to be used. Ensure your surgeon is very experienced & trust their judgement. The worst case scenario would be to attempt a pedicled technique & end up with necrosis. Be very wary of someone that can promise a much smaller size without grafts at your dimensions. All the very best

FNG is not determined entirely by notch to nipple distance, but also by how much reduction you desire. The longer the breast, the more tissue you need to maintain for nipple blood flow and hence the less reduction you can achieve. With your breasts, the chance of sensory loss even without FNG is very high so don't count on having feeling no matter what technique you use.If you want a significant reduction, a FNG may be the best way to go.