Free nipple graft - would I be able to breastfeed in the future? (Photo)

Question

I’m having second thoughts about my surgery scheduled in December. My surgeon says that he can only do a FNG, I’m a DD and my insurance approved my surgery so I’m unable to chose the size I want. I’m 24 and I have one kid but I’m thinking long and hard about my decision. Will the FNG completely take away my ability to breastfeed in the future? Is it worth getting a second opinion to see if another surgeon can do the surgery without a FNG

Laura Roider, MD · Answer

@Enthusiastic484638, 
In short, you will NOT be able to breastfeed in the future if you have a free nipple graft. The reason is when this surgery is performed we remove the nipple and it survives as a skin graft. This severs the connection between the nipple and the milk ducts within your breast. 
Each surgeon has their own preferences/experiences with breast reduction and knows what works in their hands. You could be a candidate for an alternative technique to preserve your ability to breastfeed in the future is important to you.

Joshua Cooper, MD, FACS · Answer

Women who have undergone a free nipple graft will not be able to breastfeed afterwards. During a free nipple graft, the ducts connecting your nipple to the milk-producing glanduar tissue is completely divided. Your options are to wait to have a breast reduction after breastfeeding, or you could get a second opinion and see another plastic surgeon. He/she may examine you and determine that a breast reduction with a pedicle (not free nipple graft) could be an option for you. Without seeing you in person I cannot tell you for certain that a breast reduction without a free nipple graft is your best option. Also, do keep in mind that even if you have a breast reduction and a free nipple graft is not used, your chances of breast feeding without the need for formula supplementation is still lower than for women who haven't had a breast reduction.  Best of luck to you, and thanks for sharing! You will be so happy with a breast reduction. It will change your life!

Andac Aykan, MD · Answer

Hi, great question to ask.
A free nipple graft (FNG) is usually used only when breasts are very large or very droopy and the nipple needs to be moved a long distance. In these cases, keeping the nipple attached may not be safe, so the surgeon removes it completely and grafts it back on. This is done mainly for safety.
If a free nipple graft is done, the milk ducts are cut. This means you will not be able to breastfeed in the future. Nipple sensation is also often lost.
Because you are only 24 and may want to breastfeed again, it is very reasonable to get a second opinion. Some surgeons can do large breast reductions without a free nipple graft, depending on experience and technique.
Andaç Aykan, MD, Assoc. Prof.

Emre Guvercin, MD, FEBOPRAS · Answer

This is a very important question &mdash; and at 24 years old, you are absolutely right to pause and think carefully before proceeding.Will a Free Nipple Graft (FNG) eliminate breastfeeding ability?Yes &mdash; in almost all cases, a free nipple graft permanently eliminates the ability to breastfeed.With an FNG:The nipple–areola complex is completely detachedMilk ducts and nerves are cutThe nipple is reapplied as a skin graft onlyBreastfeeding is no longer possibleNipple sensation is often significantly reduced or lostSo if future breastfeeding matters to you at all, this is a major and irreversible consequence.Is a Free Nipple Graft the only option for a DD cup?No &mdash; not automatically.In many cases, a DD cup can be safely reduced without a free nipple graft, especially in:Young patientsHealthy non-smokersPatients with good tissue qualityThis is where a Push-Up Breast Reduction & Lift comes inA Push-Up Breast Reduction is different from older, more aggressive reduction techniques.With this approach:The nipple remains attached to its blood supplyMilk ducts and nerves are preservedThe breast is reduced and reshapedThe remaining tissue is repositioned upward (not just removed)Breastfeeding potential and sensation are maximally preservedIn experienced hands, reductions of up to ~2000 grams per breast can often be performed without a free nipple graft, while maintaining nipple safety.Should you get a second opinion?Yes &mdash; absolutely.Especially because:You are youngYou already have one childYou are thinking about future breastfeedingAn FNG is permanent and non-reversibleA second opinion with a surgeon experienced in modern, tissue-preserving (Push-Up) breast reduction techniques is very reasonable and often changes the surgical plan.Insurance approval does not mean a free nipple graft is mandatory &mdash; it simply means the reduction is medically justified. Technique choice still matters.

Elisa Stein, MD · Answer

Enthusiastic484638,
Free nipple grafts are done when the blood flow to the nipple in a breast reduction surgery will be so compromised that your surgeon is worried about the health of the nipple. That happens when too little tissue is left behind to ensure enough blood vessels can be preserved. If your surgeon is worried about having to take away so much tissue to get your breast reduction covered, perhaps you are better served by having a breast lift with a smaller amount of breast tissue removed.
You are correct in worrying about breast feeding after a free nipple graft. In that procedure the nipple is completely detached from the milk ducts and its then sewed back on in a new higher location. Those milk ducts will not reconnect themselves to the nipple so no more breast feeding can happen. In a traditional breast reduction the areolar diameter is made smaller but the nipple remains connected to the breast tissue and the majority of women go on to breast feed successfully if desired. 
Dr Stein

Amir Ghaznavi, MD, MBA, FACS · Answer

Enthusiastic484638,
Thanks for your question. Unfortunately, after an FNG, you will not be able to breastfeed. The procedure entails removing the nipple from the breast (cutting all the milk channels) and "planting" it in its new position. A second opinion can always help you make a decision about an FNG.
Hope that helps.

Daniel Barrett, MD · Answer

Dear Enthusiastic484638,

any breast surgery has possible complications in terms of loss of ability to breastfeed, and the chance of this in the case of a free nipple graft is high. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. 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

Cihan Sahin, MD · Answer

If you did not have any reduction procedure before your nipples can be protected. Breast reduction can be done without FNG.

Jacob Carlson, MD · Answer

If you are wanting to breastfeed, I would recommend deferring your reduction until after you have had children or finding a surgeon who feels confident that the surgery can be done in such a way that the nipple is not removed from the body. When we perform a free nipple graft, the nipple and areola are completely detached from the body. The nerve and ducts connected to the nipple (which are involved in the milk production and lactation process) are cut. The nipple and areolae are then reattached to the breast in a new location and sutured in place as a skin graft. Since the nerves and ducts are not reattached, the ability to breastfeed after a FNG is very very unlikely.

James N. Romanelli, MD, FACS · Answer

Dear Enthusiastic

Great question.  With a free nipple graft is will not be possible to breastfeed in the future.  If this is not okay for you I suggest you seek additional opinions.  Different surgeons employ different methods.

The link shows a woman with low breasts--in her case I was able to leave the nipple attached to the underlying breast tissue, which preserves the possibility of breast feeding.

Best of luck!
Dr. Jim Romanelli

Free nipple graft - would I be able to breastfeed in the future? (Photo)

Answers (14)

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