Is a FNG the only way to remove the majority of the weight of my breasts? (photo)

Question

I have 34FF (42" at fullest) breasts and dense tissue. My surgeon said he's unable to reduce my size to C or B or salvage my nipples as my breasts are too saggy. He proposed a FNG and removal of 300g from each, leaving me with a 25% chance of no breast tissue and 75% of an A cup. The only other procedure he would do is a lift/reduction of approximately 50g. My N2N is 27cm and F2N is 17cm. Can you recommend a good surgeon who can preserve my nipples and reduce my size to a medium B or small C?

Daniel A. Medalie, MD · Answer

HI,Based on your pictures you should be able to get to a C cup without free nipple grafting. I would strongly recommend seeing another surgeon in consultation and making sure that you are fully comfortable with whoever performs the operation. I also strongly advise against free nipple grafting. It is only reserved for the largest reductions and you fall well below that criteria.Regards,Daniel A. Medalie MD

Gary M. Horndeski, MD · Answer

You
are an excellent candidate for 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 and the ability to breast feed are maintained.  I would never recommend a free nipple graft.Best Wishes,Gary Horndeski, M.D.

Erik Miles, MD, FACS · Answer

Based on your measurements and photographs, you are not a very large breast reduction.  It is true that to preserve the nipple the surgeon needs to leave an adequate amount of breast tissue behind (the pedicle).  However you do not appear to be someone who would require a nipple graft. I would seek a second opinion.  Best wishes.

Karl William Schwarz, MD · Answer

What?! That doesn’t make a lot of sense. You don’t need a free nipple graft! You can undergo a regular breast reduction and reduce your breast to a B or C cup. You have a lot of breast tissue on the outside of your breast that can be removed and I would leave more tissue on the inside aspect of your breast to preserve your cleavage.
For me I don’t go by cup size but if someone wants to be very small what I do is to try and make them as small as I can but still preserve enough breast tissue so as to maintain a pretty shape. But I would not recommend a free nipple graft as they do not look very good at all and you lose all projection of the nipple and the scaring is not typically very good.

Steven Wallach, MD · Answer

In my opinion, based upon your photos, you can have a traditional breast reduction using a pedicle and a "T" closure without requiring a free nipple graft. Best to be assessed in person.

William B. Rosenblatt, MD · Answer

YOU DO NOT NEED A FNG ---  I have been doing breast reductions for over 30 years and have only done FNGs a few times -- the last time, I took 3500g (thats 7 lbs) off each breast. Get a second opinion. You can easily have your breasts reduced with leaving your nipples attached to a pedicle. Only removing 300 g / side is a  very small reduction --- do not go for a FNG.

Robert L. Kraft, MD, FACS · Answer

If you are a true F cup, the reduction would be far more than 300 g per breast.  In New York, it would be impossible to obtain insurance authorization for such a small reduction.  Based on the photo, I would not recommend FNG as a standard procedure. There is absolutely no reason why you cannot be a B or C cup postoperatively.  Please consider a second surgical opinion.

Richard M. Levin, MD (retired) · Answer

If your goal having surgery to your breasts is to remove "considerable amounts" of breast tissue, that operation usually is titled a breast reduction and usually involves insurance coverage.  The weight of breast tissue removed is then determined by a scale called body surface area and varies accordiing to your height and weight and mostly results in removing "most" of the weight of your breasts, which is of course subjective but ususally true. Removing breast tissue to the patients choice of final size, however, with the use of goal photos, does not usually meet insurance standards and is called a Mastopexy which removes the large amount of excess skin you have and "some" breast tissue. 
In your case, both operations breast reduction or mastopexy,  would not involve or require a FNG ( free nipple graft ) and both would allow your nipple areola to remain attached on tissue with its own blood supply and sensation intact. Free nipple grafting is reserved for breasts much larger than yours in general. Never be embarrased to seek and ask more questions of your choice of surgeon or surgeons.

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