Free nipple graft for a breast reduction
Free nipple grafts are not always necessary but it's an important consideration to be made aware of during the informed consent process. During a breast reduction the nipple and areola are repositioned by keeping them attached to underlying soft tissues so that they continue to have a robust blood supply. We call this leash of underlying tissue a pedicle. If the pedicle is excessively long, or will link with rotation, or if the patient has underlying risk factors to compromise blood flow, such as smoking, then the nipple and areola may not receive the necessary blood supply to survive. If this is bound to occur, it's better to do a free nipple graft during surgery then slowly watch the nipple and areola slowly die and scab over postoperatively. I typically wouldn't expect a free nipple graft to be necessary for the breasts shown in your photos, but I would at least acquire consent to do so if I noted during surgery that the nipple and areola was clearly not getting enough blood supply. Odds are you probably won't need it. Most importantly, be sure you are evaluated by a plastic surgeon certified by the American Board of Plastic Surgery in order to get a qualified, expert opinion on your surgical options and expectations.
Best of luck,
Keith M. Blechman, MD
New York, NY
NO Free Nipple
absolutely NOT! If your surgeon recommended a free nipple graft he or she is not an experienced board certified plastic surgeon. You are an excellent candidate for pedicle wise pattern technique reduction. I have done much larger patients than you and left the nipple attached. I would seek a second opinion so you don't end up with a nipple with no sensation. I think sensation and pretty scars are very important. Sorry to be so opinionated, but on this issue I am very passionate.
Is free nipple graft the best option for me?
Congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform. Based on your photographs, measurements, and description of preferences, I would not recommend free nipple grafting. I think that it is very likely, that a well executed pedicle based breast reduction procedure will achieve your desired outcome nicely. Be careful about communicating your goals in terms of cup sizes; as you know, this form of communication may be a source of confusion. In my practice, I ask patients to communicate using goal photographs as much as possible. Best wishes for an outcome that you will be very pleased with.
Free nipple grafting is a valid technique
Free nipple grafting is a totally valid option for you. However, given that you only want to go down to a C or D, I would probably plan to do a pedicle reduction. Free nipple grafting is always an option if the nipple circulation appears compromised during the procedure. Board certified plastic surgeons should know how to do the free nipple grafting technique in case it is necessary. Still, get a second opinion.
Free nipple graft for Breast Reduction
I can not be sure without examining you but I very rarely do free nipple grafts. I would normally expect that I would use a pedicle technique for someone like you.
I most frequently use free nipple grafts when there has been previous surgery around the nipple so the blood supply may be compromised. It is possible to plan a pedicle technique and switch to a free nipple graft during the operation if it appears that the nipple has lost its blood supply.
As always I must advise you to see a suitably qualified and experienced plastic surgeon to help you with your decision.