Do I really need a free nipple graft?

Question

I went to see a plastic surgeon about getting a breast reduction. I'm a size 40ddd. And would like to go down to a c cup. He said I'd need to have a nipple graft. Something about me being 24 cm or something. I'd just like some opinions please. I'm 22 by the way. I don't mind losing sensation and I don't plan on having any more kids so not being able to breast feed isn't an issue. But is this nipple graft thing more risky than not getting one?

Larry S. Nichter, MD, MS, FACS · Answer

In my experience I am able to successfully use a more traditional approach using the lollipop or inverted T procedure without resorting to a free nipple graft technique for a DDD to C  cup reduction. Free Nipple Graft is only required in reduction of massively enlarged breasts (typically larger your cup size. It results in inability to breast feed, loss of sensation, loss of nipple projection, incomplete take of the nipple/areolar graft and other complications can occur with this procedure. In my practice this is a very unusual as even very large breasts can be reduced with other techniques. On the other hand this is a technique that should be considered when it is expected that there is not sufficient blood supply for the nipple and areola survival in extreme cases. One option your surgeon can try is to see if the nipple/areola has a sufficient blood supply at the time of surgery. If not he can then choose to use this technique.

Gary M. Horndeski, MD · Answer

At
size 40 DDD each 300 gram removal corresponds to 1 cup size change.900 gram removal (approximately 2 lbs) would
take you down to a size C.I have
removed 5 lbs on a patient without requiring a nipple graft.Her nipples hung to her wrist and she underwent
a lift without a nipple graft while maintaining nipple sensation and the
ability to breast feed.I recommend a
new technique called The Ultimate Breast Reduction&trade;.The breast tissue is reshaped creating upper
pole fullness, elevated higher on the chest wall and more medial to increase
your cleavage.The weight of the breast
is transferred to the underlying muscle resulting in immediate pain relief
without excessive reduction.This
technique avoids the ugly vertical scars of the traditional technique,
maintains nipple sensation and the ability to breast feed.Best Wishes,Gary Horndeski, M.D.

Vincent N. Zubowicz, MD · Answer

If you wonder whether or not a nipple graft is necessary it probably is a good idea to get a second opinion. Posting the photograph would be useful as well.

Jason Mussman, MD · Answer

Free nipple grafts can be performed as part of the primary breast reduction plan or as a backup plan if the nipple looks threatened.  In my practice, free nipple grafts are almost never performed.  I would get a second opinion and be comfortable with your plan prior to the elective surgery.

Robert M. Freund, MD · Answer

When a doctor performs a breast reduction surgery, the nipple and areola is moved to a higher and more desirable location on the breast. The tissue can move with its blood supply or transferred as a skin graft - similar to sod being planted in your backyard. If the tissue moves with its own blood supply, it will look normal and may feel normal. If a free nipple graft is performed, the color of the areola may change, the sensation will be lost and the ability for the nipple to maintain erection may be lost.Different procedures or techniques will have limitations that may or may not require a free nipple graft.Get several opinions of different doctors who perform different techniques to see what your true options are.For more information about your options, read my book, "Cosmetic Breast Surgery - a complete guide from A to double D".

Lavinia K. Chong, MD · Answer

FNG is a technique of breast reduction which is useful for the following patient scenarios:a. women whose medical conditions require a short operative time.  FNG is a relatively quick procedure;b. women who have experienced vascular compromise of their nipple-areolar complexes, after a standard breast reduction technique.  It is preferable to re-explore, remove and replace the NAC in order to ensure a "closed" wound, rather than allow the nipple-areolar complex necrose (die) and leave a large deficit in the breast;c.women with gigantomastia where the distance between the nipple and the clavicles is very long, >30cm;If your case doesn't conform to any of these, you might revisit this technique with your PS and ask why another might not be substituted.  FNG techniques can yield very good shapes and preservation of the NAC, however you should be aware that the trade-offs are as follows:a. loss of sensibility of the NAC;b. inability to lactate as the ductal system is divided;c. temporary discoloration of the NAC in dark complected individuals.Hope this helps. Good luck.

Steven Wallach, MD · Answer

A free nipple graft is sometimes used for patients with very large pedicle lengths.  You would have to be seen in person to be properly evaluated.

Anne Taylor, MD · Answer

Hi!It is hard to know exactly how to answer, with out seeing you  in person, but for me,I hardly ever do the free nipple graft, due to the issues you mention, with lack of sensation. If your plastic surgeon has mentioned this, it can be due to the very large amount of breast tissue that is anticipated to be removed- usually more that 2-3 pounds per side.Often the free nipple graft is used if the nipple appears to be stressed by the amount of tissue removed, and this decision is made in the OR, as plan B.Breast Wishes.

Luis E. Redondo, MD · Answer

There are a few techniques that can achieve great results on really big breast especially when the nipple is too low, one of them is nipple graft, which has really great results but its not the only one. techniques are a lot surgeon dependent, you should find a Board Certified Plastic Surgeon who you trust and leave the technique selection to him/her, Nipple survivor its priority number one on every plastic surgeon and we will select the technique on which we can achieve better results.Best wishes,

Alan M. Engler, MD, FACS (retired) · Answer

It's hard to tell without a photo.  But I share your questioning that, particularly if you're accurate in remembering 24 cm.  That typically refers to the distance to the nipple from either the sternal notch between the collarbones (not likely if you were discussing a free nipple graft) or from the inframammary crease (under the breast).  If it's the latter then that is, actually, a fairly long pedicle.But for a young otherwise healthy woman an inferior pedicle breast reduction may be a more reasonable approach, with the understanding that it may need to be converted to a free nipple graft if the blood supply is inadequate.If there is any question (and it sounds like there is) seek additional in-person consultations with board-certified plastic surgeons and see what your options are.  If they all say the same thing then you can reasonably assume that that's the best thing for you; if not, you'll have some choices.I hope that this helps and good luck,Dr. Alan EnglerMember of RealSelf100

Do I really need a free nipple graft?

Answers (10)

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