Odds of Receiving a Free Nipple Graft?

Question

Hello, I am a 23F, height 5'5" and 155 lbs. Currently I wear a 34G bra size. I recently had two consultations with two different surgeons about receiving a breast reduction. Both said they would submit my information to my insurance. Doc 1 said he'd remove ~600 grams while Doc 2 said ~400. My current measurements are: Right SN-N: 34 cm Areola ht: 7.5 cm N-IMF: 11 cm Base: 15 cm Left SN-N: 34.5 cm Areola ht: 8 cm N-IMF: 11 cm Base: 15 cm Will I likely need a FNG?

Ryan Rebowe, MD · Answer

The risk of receiving a free nipple graft depend on what pedicle to use, meaning how the nipple is kept alive. This is generally done by keeping it alive from the inferior aspect (utilizing the N:IMF distance) or superior/superomedial aspect (using the SN:N distance). Your N:IMF distance is more than adequate for an inferior pedicle, minimizing the risk of requiring a free nipple graft. However, the only way to really tell is to examine you in person. With those measurements and the amount of tissue predicted to be resected, it would be highly unlikely to receive a free nipple graft as part of the surgical plan.

Gary M. Horndeski, MD · Answer

The technique I recommend is The Bellesoma Method. This will reduce and reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This technique does not require a free nipple graft. This technique is not covered by insurance.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Tommaso Addona, MD · Answer

Thank you for your question.
Without photos it is difficult to say; however, based on your measurements you may be a candidate for a free nipple graft. Measurements alone will not warrant whether or not this procedure is required at the time of breast reduction; it mainly has to do with the blood supply to the nipple. I recommend speaking with your plastic surgeon to discuss your concerns.

Daniel Barrett, MD · Answer

Dear bdubs2,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Anna Steve, MD · Answer

Breast reduction can be performed safely without free nipple graft in the majority of cases. The risk of problems with blood supply to the nipple and need for a free nipple graft can increase with a number of different factors. Your breast dimensions alone would not commit you to requiring a free nipple graft.

Eric Maiorino, MD · Answer

While every surgeons threshold for a free nipple graft is different, I usually don't worry about the need for a free nipple graft until the N-IMF measurement reaches 18-19cm or if the patient wants a significantly smaller breast cup (aka going from a G to an A cup). I do discuss with each patient the potential risk of inadequate blood supply to the nipple after the breast has been made smaller and lifted and if that is seen during surgery that a free nipple graft may be required to save the nipple but this would be rather rare in your situation. Hope this helps!

J. Michael Morrissey, MD (in memoriam) · Answer

Thank you for your question. The free nipple graft technique is the surgeons last resort. Typically used when the breasts are very very large. With the measurements you submitted, I do not think you are anywhere near large enough to need a free nipple graft. The free nipple graft leaves the nipples insensate and often heals poorly and is the surgeons last resort. If the surgeon you have consulted with recommended FNG, I would suggest that you keep looking..!
Best wishes, Dr. Morrissey

Jeffrey C. Hamm, MD - Account Suspended · Answer

Hi and welcome to our forum!
Breast reduction surgery is most commonly performed by maintaining the nipple areolar complex on a vascular segment (pedicle) of underlying tissue, removing excess breast tissue, soft tissue and skin, and placing the areola and its underlying tissue into an inferiorly based "keyhole" pattern of skin, created after excess tissue is removed. There is a limitation in the amount of reduction with this method as the vascular segment of tissue must be wide enough and thick enough to maintain viability. A bulky flap will not fit.
If the distance from the top of the breast bone to the nipple exceeds 40 cm, a graft should be considered as the flap may be too long to support blood supply to the nipple areolar complex.
At your age and the distances quoted, you most likely will not need a graft.
Best wishes...

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