Is a free nipple graft really necessary? My surgeon says it is due to my size (Photo)

Thank you for your picture. It really depends on your measurement from the start on to the nipples. Your picture indicates that this is a Great distance. If that distance in my penis over 40 cm and a free nipple graft is indicated.

Free Nipple Graft is only required in reduction of massively enlarged breasts such as your cup size would qualify for this. 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 then she can go ahead with the free graft technique which sounds like the approach she is using.

During a typical breast reduction, the nipple and areola is left attached to a portion of the breast tissue called a pedicle.  The larger and longer the breasts are, the longer the pedicle is and the higher the risk of blood flow problems in the nipple.  If the nipple doesn't get enough blood flow, there can be significant healing problems or, in a worse case scenario, the nipple and areola could actually die.In patients who are at a high risk of this problem, many times a free nipple graft is recommended without even an attempt to leave the nipple attached (to "save" the nipple).  Though there are significant disadvantages to a free nipple graft (the nipple is numb, non-functional, cannot be stimulated, may lose some pigmentation, tends to be more 2-dimensional), it is certainly a better alternative to a dead nipple and areola.The fact that your surgeon is going to try to leave your nipple attached is the best you can hope for given your breast size and shape.  If your nipples look healthy during surgery, they'll be left attached.  If not, your surgeon will make the decision to do a free nipple graft rather than risk a nipple catastrophe.  If you're just not willing to have a free nipple graft, don't have breast reduction surgery.

By the appearance in your photo you appear to be a good candidate for a free nipple graft breast reduction. I would trust your plastic surgeon and his/her experience if you feel comfortable with him/her. This is a decision that has to be made with a formal consultation and examination. 

Thank you for the question and picture. Although, this may not be answering your question directly, I think that you will be better off achieving close to your long-term stable weight prior to proceeding with breast reduction surgery. Doing so will decrease risk of complications and likely improve outcome as well. Then, choose your plastic surgeon carefully and allow him/her to use their best judgment when it comes to the details of the operations such as technique utilized (hopefully based on many years of experience) to achieve the best outcome possible.  Best wishes.

Your nipples are down to your umbi and the root of your breast above looks thin. This means that there can be blood flow issues trying to keep your nipple alive on the breast. Your doctor is correct to advise you that they might need to convert to a FNG during surgery.