To me, you like a straight forward pedicle breast reduction maintaining the nipple on a pedicle and likely closing the incisions with an anchor type repair ( inverted T). I have performed much larger reductions than that using a pedicle technique and not having to resort to a free nipple graft.
A Free Nipple Graft is not needed for your reduction. I simple breast reduction is all that is needed. I recommend an in-office examination as well as a detailed discussion with a board-certified Plastic Surgeon certified by the American Board of Plastic Surgery.
Harvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon
Thank you for the clarification. You appear to be noone whom I would ever consider a free nipple graft. The last one I did was right out of residency and well over 30 years ago. Many physicians get trapped into doing every breast the same way, and what works for someone where the nipple has to be moved a short distance does not work for someone where the nipple has to be moved more. By modifying the procedure and the vascular support for the nipple, I, and most other good plastic surgeons, have been able to preserve the nipple's natural blood supply so a free nipple graft is not necessary. In fact, by modifying the pedicle, I have also improved the support of the tissues so I get almost no bottoming out and the breast retains its shape. I would advise seeing another plastic surgeon as there is, in someone like you, no reason for a free nipple graft.
I think there are two principle reasons to perform a reduction with a free nipple graft. The first is the length of the pedicle and the risk of necrosis with an overly long pedicle. The second reason is the limitation in the amount of tissue that can be removed when the surgeon needs a long pedicle to ensure the blood supply to the nipple. There are several drawbacks to a FNG including possible necrosis, pigmentation issues, and loss of sensation. Generally speaking I try to avoid a FNG if possible. My general rule of thumb is a notch to nipple of more than 35-40 cm.