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.