What options do I have to get nipple projection after nipple necrosis from free nipple graft during my breast reduction? (Photo)

Question

I had a breast reduction with free nipple graft a little over 5 months ago. I was a G cup and wanted to go to a C/D cup. My board certified, top rated surgeon told me that having a free nipple graft was the standard of care because any other method would certainly fail due to poor blood flow/circulation. I still have the areola in one breast, but it is only partially there in the other breast. What are my options besides a tattoo? My surgeon says there is nothing she can do. Thank you!

Vincent N. Zubowicz, MD · Answer

In patients with heroically large breast it sometimes is safer to graft the nipple and areola on a redeveloped breast mound. This can lead to volume deficiency in the nipple proper. This can be treated with fillers or with inserts but only after information is completely subsided.

Robert F. Centeno, MD, FACS · Answer

Once the scar has completely healed and softened, there are options for improving nipple projection.  Injection of absorbable fillers is a safe and effective way to improve nipple projection but will have to be repeated 1-2 times per year.  A nipple graft with a product such as Surgisis nipple cylinders may also be beneficial and improve longevity of the projection.  A nipple flap is riskier as you had a nipple areolar graft.  None of these options are permanent, but will help your situation. Finally, really expert tatoo artists who specialize in nipple areolar tatooing can tatoo a very realisitic looking nipple even though you may still not have the projection you want.  Best wishes.  Check out the link below on a story about one of the most talented nipple tatoo artists.

David R. Alfonso, MD, FACS · Answer

Achieving nipple projection with a reconstruction can be difficult. It appears that your other nipple is also somewhat flat which prevents you from doing a nipple sharing technique. Tattooing can give the appearance of a nipple in the right hands. If you want to try reconstruction I would wait a few months until the scar is softer and will allow for more tissue response Good luck

Nelson Castillo, MD · Answer

Thank you for your question and I am sorry to hear of your healing issues.  Because maintaining nipple projection is a very difficult endeavor with either free nipple grafts or with a nipple reconstruction, preserving the nipple at all costs is an important part of the reduction process.  With larger reductions, the blood supply to the nipple may become threatened necessitating grafting.  Options that you have include minimally invasive procedures, such as tattooing, or surgical options, including nipple reconstruction, or placement of prosthetic material within the nipple.  These latter methods still have difficulty maintaining long term projection and tend to flatten with time.

Sheila S. Nazarian, MD · Answer

I am so sorry that you've had this experience with your nipples. Based solely on your photos, it looks as if your best option is a tattoo, but you might want to seek a second in person opinion from another surgeon in your area. Maybe one who deals with a lot of breast reconstructions. Best, Dr. Nazarian

Steven Wallach, MD · Answer

A free nipple graft will often prevent the nipple from becoming erect from stimulation because the innervation is cut and the tissues underneath the free nipple are thinned so that it can survive.

Susan MacLennan, MD · Answer

HelloI'm sorry that you had trouble with your postop healing. The nipples often do end up quite flat after free nipple graft, even when healing is straightforward. I would recommend giving it a bit more time (at least several months) so the scars can soften and heal fully. It may be possible to reconstruct a nipple using a variety of techniques. Sometimes the thick scar can be used to your advantage, but it will take a surgeon who is very experienced with nipple reconstruction to help you determine what would work best in your case and what could be done safely. Tattooing would probably also be necessary after nipple reconstruction. There certainly is hope for you; don't get discouraged but do be patient!Best wishes-

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for your question and nipple and areola reconstruction can easilybbe performed to reconstruct what you have lost.  So see some experts in the fieldDr Corbin

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

I'm obviously very sorry about the experience you've had.Nipple reconstruction can be difficult to achieve - from the standpoint of projection on a long-term basis - even when using non-scarred tissue.  Based on this photo I would probably agree that a tattoo is the way to go.  Improvement in technique demonstrate better shadowing effects that mimic projection, and it's a (relatively) simple procedure to go through, particularly when compared with a surgical technique.You should of course have this confirmed with one or more consultations with board-certified plastic surgeons who can examine you in person.I hope that this helps and good luck,Dr. Alan EnglerMember of #RealSelf100

What options do I have to get nipple projection after nipple necrosis from free nipple graft during my breast reduction? (Photo)

Answers (9)

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