Should I consider having a FNG done? (photos)

Question

I’m just wondering would I need a FNG. My surgeon said if I wanted to get to a B cup that’s the best route. But said it’s up to me the other route would get me smaller and “proportional”. I’m so scared I want my nipple sensation and he also said being African American the color can change. Then I don’t want 2 different shape nipples I wasn’t them the same exact size. I need advise please and Thanks in Advance

Krishna Vyas, MD, PhD, MHS · Answer

It's completely understandable to feel anxious about your breast reduction surgery, especially when considering factors like nipple sensation, shape, and skin color changes. Whether or not you need a free nipple graft depends on several factors, including the amount of tissue to be removed and your surgeon’s technique.

First, I would not focus on "cup size" but perhaps a percentage of what you want removed per breast. I typically use the 50% as a reference to see if this is “too big, too small, or just right” for the patient’s expectations. Based on the photo, I would expect a reduction could be achieved without a free nipple graft and utilizing standard pedicle technique for breast reduction surgery.

Typically, a Free Nipple Graft is required in cases where a significant amount of tissue is removed, or if the nipple needs to be repositioned significantly higher on the breast. In these cases, the nipple is detached from the underlying tissue and reattached in a new location. However, this method can result in a loss of sensation in the nipple area, and the color and size of the nipples can also change. Since you expressed concerns about nipple sensation and appearance, this would be something important to discuss with your surgeon, who can guide you in selecting the best approach based on your goals.

On the other hand, a traditional breast reduction technique (such as the anchor or vertical incision method) typically allows for the preservation of nipple sensation, and the nipples are usually resized and repositioned but remain attached to the underlying tissue. This means the nipple can maintain its blood supply, sensation, and color.

To ensure you feel confident and comfortable with your decision, be sure to discuss all your concerns, including nipple symmetry, sensation, and color changes, so your surgeon can tailor the procedure to meet your aesthetic goals.

Best wishes,

Dr. Krishna Vyas, MD, PhD, MHS
Harvard, Johns Hopkins, & Mayo Clinic Educated
Double Fellowship Trained 
Aesthetic Plastic Surgeon
New York, New York

Joel Patrick Maier, MD · Answer

It is true that your surgeon can be more aggressive in volume reduction with FNG, but your points are valid. I counsel patients that they will end up around a "C" cup with this operation generally speaking. Nipple sensation changes are always possible with this operation. Having said that,  I think you will have a nice result and be very happy with a standard pedicle reduction mammmopalsty.

Gary M. Horndeski, MD · Answer

I do not recommend free nipple grafts. 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.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

I think most surgeons would be able to do your reduction without a free nipple graft. You probably would not want a b cup anyway. Settle for c cup. It’ll look better

Karl William Schwarz, MD · Answer

FNGs will not leave you with sensation of your nipples or areola. I think when patients think of a FNG they think of the exact same nipple areola complexes (NACs) they have now but just smaller and perfectly round in a new location after a graft, but that's not the usual outcome. Typically there is some loss of the areola and pigment changes and flattening of the nipple so one must think long and hard about undergoing a FNG. I left you a link to a video that you might find helpful.

Connie Hiers, MD, FACS · Answer

I do not recommend having the free nipple grafts. Taking you down to a B cup would require this to keep your nipples alive. You would lose all sensation and function with free grafts. I suggest going down to a more reasonable size, like C-D, that is safe to your nipples and leave you with breasts that look and feel good and that you can enjoy. You may not realize just how flat a B cup is, especially on your frame.  Your surgeon wants you to be happy with your new size and shape.

Darryl J. Blinski, MD · Answer

Any surgery, especially breast reductions there are positive negatives or the wrist benefit ratios to achieve results to correct the deformity you have. You must understand these risk and also the benefits and see if the benefits are outweigh the risk. Risk or complications or unforeseen events and they can occur in any case. Best to seek a few in person or virtual consultations for better explanations.

Mats Hagstrom, MD (license on probation) · Answer

A true pick up is going to be disproportionately small on your body.
You may be wanting a dramatic breast reduction, but I think a pick up is overshooting
The more tissue that’s removed during the procedure the higher, the risk of having severe tissue healing complications.
This can be avoided by doing an amputation type breast reduction with a free nipple graft.
 in order to preserve, the nipple needs to be divided into different segments and tissue is removed from each of the segments.
The central part of the breast that maintains connection and blood supply to the nipple needs to be kept at a certain size in order to maintain sufficient blood supply to the nipple during the healing process.
There’s also limits to how much tissue can be removed from the surrounding tissue segments.
With almost every plastic surgery procedure the most important variable is provider selection, and some may argue that provider selection that may even be more important than what procedure or technique is chosen.
 When the nipples are put on nipple graphs, a chance of the graft not surviving.
This would leave you with a scar and no nipple.
I suggest you ask providers to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar body characteristics to you before surgery.
 Bring pictures of yourself to use as reference during each consultation.
Don’t rely on memory to remember what your body looks like.
To find the right provider, I suggest having multiple consultations.
There’s no correct number of consultations needed to find the right provider.
The more consultations you have the more likely you are to find the better provider for your needs.
 The biggest mistake I see patient is having only one consultation and then scheduling surgery.
For breast reduction surgery there is also the importance of the procedure is going to be done as an aesthetic operation or insurance based.
In your case of breast reduction should that question be covered by medical insurance.
Some plastic surgeons do not accept medical insurance Because of the low reimbursement rates.
If you truly want to be a bee cup, which would entail removing 90% of your breast, then a free nipple graft may be the only safe way to get there.
Before selecting where you want to end up, I suggest you work with images and percentages rather than cup size.
Cup size is universally subjective and inaccurate.
What one person thinks is a B cup could be another person A cup or C cup or whatever. 
The best way to convey what you’re hoping to achieve is by working with images.
Have providers show you examples of previous patients and then you can point out examples of results you like from patients who look like you in the before pictures.
Highly experienced providers should have access to hundreds before and after pictures to choose from.
 The biggest mistake patients make is having only one consultation and then scheduling surgery.
Having only one consultation, more or less eliminates the ability to find the best provider for your needs.
As a general statement, I would stairway from free nipple graphs as much as possible, and instead try to use standard breast reduction techniques to get as much reduction as possible.
A second reduction is also possible and would be safer than overdoing it during the first procedure.Different providers will have different opinions.
To me provider selection is always the most important.
In the hands of the right provider you’ll be guided towards correct decisions and have the highest chance of that long-term quality outcome with the least chance of devastating complications.
Breast reduction surgery has one of the highest patient satisfaction levels of any plastic surgery operation.
This procedure also has one of the higher complication rates.
The more aggressive, the reduction is the higher the chance of having complications.
 The patients candidacy for the procedure and their overall health is also an important variable period.
For example, people who have a history of cigarette or nicotine use or any substantially higher risk for severe complications.
Good luck,
Mats Hagstrom MD

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