Do I NEED a Free Nipple Graph? I'm a 32J and I want to be as small as possible.

I am 5'9" and I weigh 186lbs. My bra size is currently a 32J. Right eternal notch to nipple distance =35.5cm. Left sternal notch to nipple distance=33.5. Right Areola to Inframammary fold distance=16cm. Left areola to Inframammary fold distance=15cm. I had 1 consultation and the PS said I needed a FNG. I asked if I can have it done supermedial so the blood supply doesn't have to travel that far and I can keep my nipple. He said no. When I weighed about 160 I wore a FF/G bra. Would that help?

Doctor Answers 13

When do you need a free nipple graft with breast reduction?

Free nipple graft refers to a surgical technique where the nipple and areola is actually cut off the patient and sewn back on in a higher position. The technique has big negatives, like no sensation, pigment changes, and no function (not connected to milk ducts). The argument for the graft is that if your nipple is really really low, then the blood supply gets so reduced that it may die from the reduction, and better something than nothing at all. Anyway, fewer and fewer doctors do grafts, because many more doctor use a medial or superior-medical pedicle (this refers to what blood supply is left intact to the nipple during the reduction), and it has naturally better flow. In my opinion, I don't even consider free grafting until 42cm, even then I probably would give it a try in the OR and see if I could retain good flow. Don't use a doctor who uses the old inferior pedicle technique, and if your doctor tells you to get a graft, he has probably had patients with nipple death/necrosis. Change Doctors.

When do you need a free nipple graft with breast reduction?

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Free nipple graft refers to a surgical technique where the nipple and areola is actually cut off the patient and sewn back on in a higher position. The technique has big negatives, like no sensation, pigment changes, and no function (not connected to milk ducts). The argument for the graft is that if your nipple is really really low, then the blood supply gets so reduced that it may die from the reduction, and better something than nothing at all. Anyway, fewer and fewer doctors do grafts, because many more doctor use a medial or superior-medical pedicle (this refers to what blood supply is left intact to the nipple during the reduction), and it has naturally better flow. In my opinion, I don't even consider free grafting until 42cm, even then I probably would give it a try in the OR and see if I could retain good flow. Don't use a doctor who uses the old inferior pedicle technique, and if your doctor tells you to get a graft, he has probably had patients with nipple death/necrosis. Change Doctors.

Do I NEED a Free Nipple Graph?

Thank you for your question. It is impossible to give an advice without a picture. However, based on the measurements that you supplied I would be surprised if you needed a free nipple graft to have a reduction. If you are trying to avoid a free nipple graft then there is a limit to how small the breast can be reduced as you will need enough tissue to keep the nipple viable.  I would recommend that you get a second opinion.

Jon E. Rast, MD
Kansas City Plastic Surgeon
5.0 out of 5 stars 33 reviews

Do I NEED a Free Nipple Graph?

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Thank you for your question. It is impossible to give an advice without a picture. However, based on the measurements that you supplied I would be surprised if you needed a free nipple graft to have a reduction. If you are trying to avoid a free nipple graft then there is a limit to how small the breast can be reduced as you will need enough tissue to keep the nipple viable.  I would recommend that you get a second opinion.

Jon E. Rast, MD
Kansas City Plastic Surgeon
5.0 out of 5 stars 33 reviews

Do I NEED a Free Nipple Graph? I'm a 32J and I want to be as small as possible.

Without photos and without examining you it is not possible to render an intelligent opinion, even though you have provided accurate measurements.  However, it seems you have done a tremendous amount of research and understand the purpose of moving the NAC on a pedicle.  I suggest you obtain opinions from several experienced plastic surgeons who have performed a large number of breast reductions of all sizes.  I personally have dealt with quite a few extremely large GG or J cup breasts without having to do a FNG.  Hope that helps.

Do I NEED a Free Nipple Graph? I'm a 32J and I want to be as small as possible.

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Without photos and without examining you it is not possible to render an intelligent opinion, even though you have provided accurate measurements.  However, it seems you have done a tremendous amount of research and understand the purpose of moving the NAC on a pedicle.  I suggest you obtain opinions from several experienced plastic surgeons who have performed a large number of breast reductions of all sizes.  I personally have dealt with quite a few extremely large GG or J cup breasts without having to do a FNG.  Hope that helps.

Reduction

Hard to tell without a photo, however seems unlikely you will need a free nipple graft.     I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).
Best,
Dr. Desai
Beverly Hills Institute for Aesthetic Plastic Surgery
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Reduction

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Hard to tell without a photo, however seems unlikely you will need a free nipple graft.     I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).
Best,
Dr. Desai
Beverly Hills Institute for Aesthetic Plastic Surgery
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Breast reduction and lift

it is very uncommon to see a patient who requires a free nipple graft.  Your case probably can be done with the standard inferior pedicles or central pedicle.  I would not recommend commuting yourself to free nipple if you don't want it.

Breast reduction and lift

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it is very uncommon to see a patient who requires a free nipple graft.  Your case probably can be done with the standard inferior pedicles or central pedicle.  I would not recommend commuting yourself to free nipple if you don't want it.

Lipolift, breast reduction, breast lift

I appreciate your question.

I perform a liposuction breast lift that removes tissue from the areas you don't want such as near the armpit and the lower portion hanging near your stomach. Once I use this to shape the breast I then remove the skin to tighten the breast and create a better shape with nice cleavage. Since I perform this less invasively the recovery time is faster and drains are not necessary. The size would depend on the proportion with your body versus going for a cup size. It works very well if there are asymmetries. I can also use fat as a natural breast augmentation by grafting the fat back into the breast to create more projection or into the top to create more cleavage. If you have shoulder grooves from your bras, I can also use fat to fill these areas in and give you more cushioning as well as contour. This procedure can also be combined with an implant if needed or wanted.  It should not affect nipple sensation, mammograms, cancer risk or breast-feeding. If you gain or lose weight, the transferred fat can do the same. Free nipple grafts are sometimes needed when blood supply is poor and the breast is very large.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic plastic surgery.  

Best of luck!    

Dr. Schwartz 

Board Certified Plastic Surgeon

#RealSelf100Surgeon 

#RealSelfCORESurgeon


Lipolift, breast reduction, breast lift

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I appreciate your question.

I perform a liposuction breast lift that removes tissue from the areas you don't want such as near the armpit and the lower portion hanging near your stomach. Once I use this to shape the breast I then remove the skin to tighten the breast and create a better shape with nice cleavage. Since I perform this less invasively the recovery time is faster and drains are not necessary. The size would depend on the proportion with your body versus going for a cup size. It works very well if there are asymmetries. I can also use fat as a natural breast augmentation by grafting the fat back into the breast to create more projection or into the top to create more cleavage. If you have shoulder grooves from your bras, I can also use fat to fill these areas in and give you more cushioning as well as contour. This procedure can also be combined with an implant if needed or wanted.  It should not affect nipple sensation, mammograms, cancer risk or breast-feeding. If you gain or lose weight, the transferred fat can do the same. Free nipple grafts are sometimes needed when blood supply is poor and the breast is very large.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic plastic surgery.  

Best of luck!    

Dr. Schwartz 

Board Certified Plastic Surgeon

#RealSelf100Surgeon 

#RealSelfCORESurgeon


Breast reduction and free nipple graft

Like some of the other respondents have said, it is pretty rare to require a free nipple graft these days in most situations, but every plastic surgeon should be comfortable with how to perform one if necessary. Most of the time, we use a pedicled technique keeping the nipple attached and only consider a free nipple if we don't like how the nipple color looks after closing up or on early followup. I have not had to do a free nipple graft on any breast reduction patients in 14 years, including doing both superomedial and inferior pedicles. I disagree with one of the other respondents here that inferior pedicle is somehow a "bad" technique or that you should not consider a surgeon who uses that technique. There are arguments to be made for different techniques. The Wise pattern skin incision gives the surgeon the ability to control vertical and horizontal skin excess better than a pure vertical technique in very large breasts, in my opinion. Of course, that does not mean one can not do a vertical pedicle (superior or superomedial) and a Wise pattern skin excision, but at the end of the day, you should be able to see a library of before and after photos of the surgeon's work with different sized preop breast sized to get an idea of what the surgeon thinks is possible for you. 

Breast reduction and free nipple graft

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Like some of the other respondents have said, it is pretty rare to require a free nipple graft these days in most situations, but every plastic surgeon should be comfortable with how to perform one if necessary. Most of the time, we use a pedicled technique keeping the nipple attached and only consider a free nipple if we don't like how the nipple color looks after closing up or on early followup. I have not had to do a free nipple graft on any breast reduction patients in 14 years, including doing both superomedial and inferior pedicles. I disagree with one of the other respondents here that inferior pedicle is somehow a "bad" technique or that you should not consider a surgeon who uses that technique. There are arguments to be made for different techniques. The Wise pattern skin incision gives the surgeon the ability to control vertical and horizontal skin excess better than a pure vertical technique in very large breasts, in my opinion. Of course, that does not mean one can not do a vertical pedicle (superior or superomedial) and a Wise pattern skin excision, but at the end of the day, you should be able to see a library of before and after photos of the surgeon's work with different sized preop breast sized to get an idea of what the surgeon thinks is possible for you. 

Exam is really needed to determine if a nipple graft is needed

but from your description and size and desires to be 'as small as possible', its likely a nipple graft will be needed and will be safer than any pedicle can be.  But if you're not wanting to be 'as small as possible', a pedicle (superior) may be considered, again, depending on how far your nipple has to be raised.

Exam is really needed to determine if a nipple graft is needed

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but from your description and size and desires to be 'as small as possible', its likely a nipple graft will be needed and will be safer than any pedicle can be.  But if you're not wanting to be 'as small as possible', a pedicle (superior) may be considered, again, depending on how far your nipple has to be raised.

Nipple to sternal notch distance

Not really sure why you would need a free nipple graft at the nipple to sternal notch distances that you are mentioning.  A photograph would be helpful to discuss your plastic surgeon's advice. There is probably something that he/she is considering other than your distances.

Nipple to sternal notch distance

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Not really sure why you would need a free nipple graft at the nipple to sternal notch distances that you are mentioning.  A photograph would be helpful to discuss your plastic surgeon's advice. There is probably something that he/she is considering other than your distances.

Breast reduction to very small size: Do I NEED a Free Nipple Graft?

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. You may be surprised to know that your goals/requests are not that unusual.   I see several patients every year who wish to achieve as small of a breast appearance outcome, for a variety of personal reasons.


 Generally speaking, it is possible to reduce the breasts size very significantly.  Based on the sophistication of your question, I think you may already understand that the concern with the amount of tissue removed is related to blood flow to the remaining tissue; if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola) may be compromised. Part of the tissue that is left in place is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue. If the pedicle is made too small (in the effort to reduce the breasts as much as possible) then patient will likely have problems with tissue survival.   Occasionally, a staged procedure is helpful; in others, nipple/areola grafting is helpful.


  In my opinion, successful outcomes with  etc. surgery depend on:


1.  Careful selection of plastic surgeon (and from the surgeon's  standpoint, careful selection of patient).  I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons. Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. ***Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.


2.  Careful communication of goals ( which I will discuss further below).


3.  Skillful execution of procedure ( preoperative, intraopererative, and postoperative patient management).


In my practice, I would ask that you NOT communicate your goals, or evaluate the outcome of the procedure performed, based on cup sizes.  There is simply too much variability when it comes to bra sizes between bra manufacturers and even store employees doing the bra fitting measurements.

 Generally speaking,  for the benefit of patients undergoing breast reduction surgery:  it will be very important to communicate your size goals with your surgeon. Most patients wish to achieve a enough of a reduction to help with their symptoms while remaining proportionate with the remainder of their torso. Again, I suggest that you do not communicate your goals in terms of achieving a specific cup size. For example, a “A or B cup” may mean different things to different people and therefore may be a source of miscommunication.


In my practice, I ask patients to communicate their goals with the help of  computer imaging and/or goal photographs,  as you have done here.  Obviously, the outcome associated with the breast surgery will not necessarily match that of goal photographs perfectly, but they do serve as a better communication tool that subjective terms such as "natural", "proportionate", "as small as possible"… Evaluating goal photographs also allows for a plastic surgeon to determine the consistency of the patient's goals and allows for a discussion of realistic expectations as well.  


***Needless to say, when it comes to achieving patient satisfaction with the outcome of surgery,  it is very important that a patient has consistent goals (fully decided on what she would like to achieve) and a good understanding of realistic expectations (what outcomes can and cannot be achieved). 

 Best wishes with your decision making and for an outcome that you will be very pleased with.

Breast reduction to very small size: Do I NEED a Free Nipple Graft?

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Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. You may be surprised to know that your goals/requests are not that unusual.   I see several patients every year who wish to achieve as small of a breast appearance outcome, for a variety of personal reasons.


 Generally speaking, it is possible to reduce the breasts size very significantly.  Based on the sophistication of your question, I think you may already understand that the concern with the amount of tissue removed is related to blood flow to the remaining tissue; if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola) may be compromised. Part of the tissue that is left in place is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue. If the pedicle is made too small (in the effort to reduce the breasts as much as possible) then patient will likely have problems with tissue survival.   Occasionally, a staged procedure is helpful; in others, nipple/areola grafting is helpful.


  In my opinion, successful outcomes with  etc. surgery depend on:


1.  Careful selection of plastic surgeon (and from the surgeon's  standpoint, careful selection of patient).  I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons. Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. ***Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.


2.  Careful communication of goals ( which I will discuss further below).


3.  Skillful execution of procedure ( preoperative, intraopererative, and postoperative patient management).


In my practice, I would ask that you NOT communicate your goals, or evaluate the outcome of the procedure performed, based on cup sizes.  There is simply too much variability when it comes to bra sizes between bra manufacturers and even store employees doing the bra fitting measurements.

 Generally speaking,  for the benefit of patients undergoing breast reduction surgery:  it will be very important to communicate your size goals with your surgeon. Most patients wish to achieve a enough of a reduction to help with their symptoms while remaining proportionate with the remainder of their torso. Again, I suggest that you do not communicate your goals in terms of achieving a specific cup size. For example, a “A or B cup” may mean different things to different people and therefore may be a source of miscommunication.


In my practice, I ask patients to communicate their goals with the help of  computer imaging and/or goal photographs,  as you have done here.  Obviously, the outcome associated with the breast surgery will not necessarily match that of goal photographs perfectly, but they do serve as a better communication tool that subjective terms such as "natural", "proportionate", "as small as possible"… Evaluating goal photographs also allows for a plastic surgeon to determine the consistency of the patient's goals and allows for a discussion of realistic expectations as well.  


***Needless to say, when it comes to achieving patient satisfaction with the outcome of surgery,  it is very important that a patient has consistent goals (fully decided on what she would like to achieve) and a good understanding of realistic expectations (what outcomes can and cannot be achieved). 

 Best wishes with your decision making and for an outcome that you will be very pleased with.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.