Will my nipple go completely flat after free nipple graft breast reduction?

Question

Having a reduction been told as nipple is 36cm away from centre of collar bone would need free graft but will only have areola not nipple left

Tommaso Addona, MD · Answer

Thank you for your question.
With a free nipple graft in a breast reduction, both the areola and nipple are apart of the graft. It is extremely unlikely for your nipple to be completely flat after reconstruction; however, since they are grafts it's likely they won't be as prominent or projected after surgery.

Alan Gonzalez, MD, FACS · Answer

Hello @ktk78 thank you for your question. I suggest you consult with several board certified plastic surgeons. When I perform a breast reduction, I try to reduce the volume of the breast tissue in the different segments. What happens? depending on the surgical technique developed by the specialist, depending on the shape of the breast, a greater reduction will be made on one segment than on the other in order to achieve the best aesthetic result. The best aesthetics result for me is a breast that has an adequate shape and proportion, that the projection is slightly conical, that has a slight descent in the upper part so that it looks esthetically adequate. When these volumes are reduced, obviously I have to make a rearrangement of all the tissues, always keeping the areola and the nipple together. I hope this shed some light. Best luck! Alan Gonzalez MD FACS

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

It is true that a free nipple grafts do tend to flatten (lose projection of the nipple) post-op, and they can also lose some of their natural pigmentation as well, making them paler in tone. There may be surgical techniques that can avoid the use of a free nipple graft, such as using an inferior pedicle technique. There are pros and cons of each approach and I would advise visiting a surgeon with a practice with a focus on plastic surgery of the breast to discuss an approach tailored to you in a face to face consultation.

Aftab Siddiqui, FRCS(Plast) · Answer

Most likely, yes. A free nipple graft breast reduction is a type of procedure where the surgeon removes the nipple and areola (the colored part around the nipple) and transplants it to a new location on the breast. This type of procedure is typically only done when the amount of tissue to be removed is very large and/or when the patient has very droopy breasts. The nipple will be permanently attached to the breast and will not be able to move or feel sensation.

Ajay Mahajan, MD, FRCS (Plast) · Answer

When the nipple areolar complex is placed as a free nipple graft, it does have to be thinned down to maxmise graft take and survival. Having said that, you don't necessarily need a free nipple graft just because the nipple to SSN distance is 36cm.

For optimal outcome, please consult a fully qualified plastic surgeon, who has specialist qualification in plastic surgery 'FRCS Plast' after having being trained adequately in the field of plastic surgery, is registered on the 'Specialist register for Plastic surgery' with the General Medical Council and has been considered competent enough to be a member of the 'BAPRAS' (British Association of Plastic Reconstructive and Aesthetic Surgeons) and 'BAAPS' (British Association of Aesthetic Plastic Surgeons) at the least.

Gary M. Horndeski, MD · Answer

I never use a free nipple graft. 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. The nipples are never removed.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

You don't necessarily need a free nipple graft. I suggest other opinions. You can probably have a standard reduction. Although you may still
Lose nipple sensation. It will at least look better

Daniel Barrett, MD · Answer

Dear ktk78,
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

Lisa Sacks, MBBCh, FRCS · Answer

Dear ktk78,I'm not sure if you've already had your operation - but I saw your question and felt I must answer it.I have been doing breast reductions for the past 27 years in some very large breasts and I have not yet had to do a free nipple graft. I have taken out up to 2kg (4lb 7oz) per breast without doing a FNG.I think it all depends on the surgeon's experience and the technique that is used to reduce your breasts.I favour the vertical scar technique where the blood supply to the nipple is retained because the bigger the breasts, the wider the stalk and the bigger the volume reduction - thus making it a safe option. I hope this information is helpful.

Vivek Sivarajan, MBChB · Answer

Hi,
Thanks for your question,
Generally speaking a free nipple graft is required when the movement of the nipple during a breast reduction is too far to be kept alive by a stalk of breast tissue under the nipple. Whilst there isn't a definite distance either from the collar bone to the nipple or a distance of how far the nipple will travel a recent study of free nipple graft procedures found that they are generally required when over 1.5kg of breast tissue needs to be removed from each breast. Maybe you could as your surgeon how much he is planning to remove?
Unfortunately a free nipple graft leaves an areola which may lose colour, loses all feeling and loses the projection of the nipple to some degree. You can also lose the entire nipple, although this is rare.
As with all breast reductions only you can weigh up the risks of the procedure against living with the large breasts that you have.
I hope this helps and if you are unsure about the procedure it never hurts to have other opinions.

Will my nipple go completely flat after free nipple graft breast reduction?

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