Risks of free nipple graft compared to no free nipple graft?

To keep the nipple area alive, enough breast tissue must be kept. This limits how small one can go with a reduction. If you want to be a B or A cup, the free nipple graft is the safest option. However, you will sacrifice function and sensation with a graft. Most women do not regain sensation. There is still a low risk of partial or complete necrosis with the graft. Please make sure of your decision, because it cannot be undone.

Free nipple grafts are not analogous to maintaining the nipple on native breast tissue. This is the case in multiple regards- firstly, you are unlikely to have any sensation to FNGs if this is done. If you do have any resulting sensation it will be extremely muted compared to your normal baseline sensation. You have already mentioned that you are not interested in breast feeding, however following FNG they would also lose any dynamic change (with temperature, stimulation etc). This may or may not be a bother to patients, everyone is different. FNGs also have a tendency to flatten out when compared to a breast reduction where the nipple is preserved on native breast tissue. Finally, any skin graft runs the risk of not adhering fully with partial nipple loss following FNG. This can be true with either FNG or in aggressive breast reductions where we are trying to take off as much breast tissue as possible while preserving some tissue to supply the nipple.
In most instances, free nipple grafting is reserved as a "last resort"- if there is considerable concern about blood flow either due to the degree of nipple elevation needed or due to breast tissue being removed. Make sure that you have a fully informed discussion with your surgeon about the differences between these options as you consider surgery.
Sean Fisher, MD Aesthetic Plastic Surgeon Seattle, WA