What's the Process for a Breast Reduction, When Would my Nipples be Grafted Back on?

I have very large pendulum breasts G cup.From what I have seen and read my nipples would have to be removed and grafted back on? Is this all done at one time? I have 45 years old 5'2" and 220 lbs. I know I will have to lose weight before surgery. Background I developed very early, my breasts sagged in my teens, weight then was 110 and DDD. I don't know if this matters but also at the age (even before) I had many stretch marks on breasts and stomach (is this a lack of a hormone or collagen).

Doctor Answers 14

Timing of free nipple grafting in breast reduction

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Should a patient require nipple grafting, in instances of extremely pendulous breasts, it would be performed as part of the breast reduction surgery.   I perform this if the nipple to infra-mammary crease distance is 24 cm or more because such a long pedicle may jeopardize the viability of the nipple-areolar complex.  

You won't need a nipple graft

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Only in very rare cases (such as a smoker with extremely large and stretched out breasts) would a free nipple graft be required and only if the surgeon feels the circulation is not adequate during the surgery. I have never known any patient in the last 15 years who needed one. Best of luck!

Daniel Yamini, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 21 reviews

Nipple graft is most likely not necessary

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I agree with you in that I would attempt to lose as much weight as possible. At that point, you'll need a breast reduction. In only rare cases are nipple grafts necessary. Sugeons often will consider performing the grafting procedure in extremely large or ptotic breast or in heavy smokers. Otherwise, there are several options aailable to restore your breasts to a more natural and youthful appearance. Thank you. 

Jeffrey D. Hoefflin, MD
Los Angeles Plastic Surgeon

Free nipple graft breast reductions

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FNG breast reductiions are rare but when done, the nipples are grafted back on at the end of the surgery, not later.

Breast reduction and nipple grafting

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I would say that I reserve free nipple grafting for the extremely larger breast reductions where the tissue carrying the nipple and areola is a very long length.  It is certainly individualized.  I probably reserve it 1 in 100 or more cases.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast reduction and the need for free nipple grafts

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The majority of breast reductions are done without removing the nipple/areola; therefore, most will not need a free nipple graft.  Sometimes if the size of the breasts is such that the blood supply to the nipple/areola will be questionable, the surgeon may decide to remove the nipples and replace them, like a skin graft, to help ensure better survival of the nipple. I rarely ever have  the need to perform free nipple grafting personally.  I recommend consulting with a board certified plastic surgeon for more information and for an examination to determine if this is necessary for you.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 410 reviews

Free Nipple Graft

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The free nipple graft is a great option and not really given adequate consideration today.   Its benefit in my hands is directly related to how much tissue can be removed.   Most women your size seem to remain quite large after a standard reduction mammoplasty.   I have had great success at obtaining large volume reductions with the free nipple graft when large reductions are necessary for very droopy breasts.   Comments like partial depigmentation, and nipple sensory loss are right on target.  You will have to be willing to accept the pigmentary changes if you are African American and the amount of depigmentation can vary.   In summary the procedure is great for those who want to lose a lot of breast weight.


Alan Weiss, MD
Baltimore Plastic Surgeon

Nipple grafting is not necessary with new technique

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Dear Samstay,

Nipple grafting is no longer necessary regardless of how large or saggy your breasts are. A new technique has been developed that preserves the vascularity of the breast where nipple loss is no longer an issue. Your breast tissue is reshaped into an internal cone (similar to that of an implant -firm and perky) and permanently attached to your chest wall to help prevent downward migration of your new breast mound.  An added benefit of this technique is that there is no vertical scar The incisions are well hidden around the areola and the natural crease under the breast. 

FYI-Liposuction for breast reduction is only successful in certain cases where the breast tissue is mostly fat and not breast parenchyma. Liposuction will only worsen already saggy breasts. Best wishes, Dr. H.

I hope this helps 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Nipple Grafting Not Very Common Today

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Nipple grafting in breast reductions is not very common today. However, if it is necessary, the graft is done at the time of the reduction and a dressing is left in place for several days until the blood supply is re-established. This can be a useful technique in extremely large breasts. Weight loss will help! Good Luck!

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 100 reviews

Breast Reduction and Free Nipple Graft

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Most breast reductions are done without nipple grafting with a variety of techniques that transpose the nipple higher on a pedicle of underlying tissue.  In some cases, however, when the breast is very large and droopy, a free nipple graft may be necessary.  In this case, you will not have normal sensation and it is not unusual to have spotty depigmentation of the areola after the nipple/areola heals.  Consult a board certified plastic surgeon in your area to see what your options are.  

Stephen Delia, MD
Boston Plastic Surgeon

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.