Possible to Go from Sagging C Cup to High A Cup with No Nipple Graft?

Would it be possible or likely to expect to go from a medium sagging C/D cup after nursing back to a high, small A cup and not have a nipple graft?

How much tissue needs to remain for the pedicle? Can it be shaped more flat with less curve?

Doctor Answers 16

Nipple graft?

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I´m kidding about the question, but nipple grafts are very rare in the breast lift plastic surgery community. Although we're all familiar with the technique, it's something that we did during residency and now we´ve all become more fascile with other, better techniques...certainly for someone with a D cup. Hopefully, nobody has recommended this to you, and if they have I might run for the hills!

Your lift can be done using several techniques, reaching an A cup is fine but remember that you've had large breasts for some time now and going to extremely small breasts may seem appealing but be sure you want that significant of a change.

Some of the other responses have mentioned a Hall-Findley lift (superomedial pedicle) and I think there is a great chance that a D cup to an A cup would be an excellent choice. Properly done, this is one of the best options available. Using a central pedicle can be somewhat difficult to decrease the size quite so significantly.

Lastly, the superior pedicle must be considered but since you need so much lift, it would require significant release laterally and medially to allow it to go up sufficiently so I recommend you stick to your board certified plastic surgeon's option. He's done them before and knows what he's capable of. With that in mind, if you are being recommended a graft, I might would consider a second opinion because the other techniques look better while achieving the same result and preserve sensation.

Best Wishes,


Dallas Plastic Surgeon
4.9 out of 5 stars 125 reviews

A cup size is an unusual request in a breast lift

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You can go quite small with a breast reduction procedure but there are scars involved. The scars would be all the way around the nipple and under the breast as well. I think a nipple graft is to be avoided unless there is no alternative, which is very rare.

If after your aggressive breast reduction there is still too much tissue for your taste then some judicious liposuction may be in order. It should be noted that your request is very unusual and body image issues may be something that you would want to explore before committing to such a radical procedure.

All the best.

Talmage J. Raine, MD, FACS
Chicago Plastic Surgeon

Breast lift or reduction

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To take someone from a "C" cup down to an "A" is not recommended. It may even be close to impossible. Maintaining the viability of the pedicle with the nipple does require some tissue, and the skin flaps need to have some tissue on it as well to survive. Unless you do a free nipple graft( which is really only done in extremely large breast reductions in women who have extremely long breasts( nipple to sternal notch distances usually exceeding 40 cms, and nipple to fold distances exceeding 20 cms), you probably will not get to the small size that you want without compromising sensation and viability of tissue.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast lift for sagging after nursing and lactation (breast feeding) without implants

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It sounds as if you are experiencing pseudoptosis (false sagging) or severe involutional atrophy of the breast (shrinkage) following nursing and lactation.

Options for management are essentially a mastopexy without implants and removal of excess skin with elevation of the nipple and rearrangement of the breast tissue.

The vast majority of the gland can remain with removal of skin primarily.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

No nipple grafting needed

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More than likely you would be able to perform the procedure without the need for nipple grafting.  Nipple grafting is reserved as an option of last resort in women who have very large long breasts and are not the best surgical candidates for a breast reduction.  It is  sort of the operation of last resort.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Breast Reduction to Very Small Size?

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Thank you for the question.

Nipple grafting will not be necessary in your case. This is usually reserved for patients undergoing extremely large breast reduction procedures;  is rarely indicated these days.

Based on your question, it is clear that you have some understanding of the problems associated with trying to reduce the breast to a very small cup size.  During breast reduction surgery is important to maintain the blood supply to all the breast tissue and the nipple/areola complexes. The blood supply to the nipple areola complexes are maintained via a “pedicle”. If this pedicle is made to small or narrow in the quest to achieve a very small breasts,  the blood flow to the nipple/areola may be compromised resulting in a ischemic nipple/areola and complications that are potentially difficult to treat.

Sometimes, when patients are very clear about their goals to achieve a very small breast size (almost flat),  then it is best to do the breast reduction procedure in 2 stages.  This allows the breast tissue and nipple/areola tissue to  acclimate to the decreased blood flow during the first stage before further reduction is performed.

Make sure you are working with well experienced board-certified plastic surgeons.

Best wishes

Breast reduction from C-D cup to A cup

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Having a breast reduction from a C-D cup to an A cup without a nipple graft is certainly possibe. Talk to your surgeon about his or her method of breast reduction, and what the risks are for loss of nipple sensation, loss of the ability to breast feed and risk of skin loss with the specific type of reduction surgery that he or she performs. Most breast reductions can be performed without having to remove the nipple areola complex and using it as a graft, but just because the nipple areola is not being removed, doesnt mean that you dont risk loss of sensation.

So, it really depends on what you are looking to achieve, and what percentage risk you take to get there. It will certainly depend on the quality and density of your breast tissue and how much of your breast volume is skin compared to parenchyma to be able to give you a better idea of your risks for sensory loss, but you can most likely achieve the volume and size you want without having to do a free nipple graft. Good luck!

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 109 reviews

Breast Lift for Sagging C Cup

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The difference between a breast lift and a breast reduction is that in a breast lift only skin is removed and sometimes only the top layer or epidermal layer is removed. So there isn't a risk of blood supply to the nipple like there can be with breast reduction.

Because you need a substantial lift you'll need the "anchor" or "wise" pattern incision the extends around the areola, down vertically to the crease then in the inframammary fold. This allows for the greatest amount of skin to be removed and simply by changing the amount of skin taken out in the vertical limbs the shape of the breast can be varied.

So no nipple graft just a standard mastopexy.

Nipple grafts very rare

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It has become extremely rare that nipple grafts are needed in either breast lift or reduction surgeries. The techniques commonly used can accommodate a very wide range of breast sizes and shapes. If your surgeon recommends one then get a second opinion.

Dean Fardo, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 15 reviews

Breast reduction from C cup to A without nipple graft is possible

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Breast reduction involves moving the nipple to a higher position and reducing breast tissue and skin. Your question is a great one because one of the things that limits our ability to make the breast really small is how much breast tissue is required to keep adequate blood supply to the nipple areolar complex. There are ways to design this remaining breast tissue, called the pedicle, so that the volume reduction can be maximized. In general, the greater the reduction, the longer the scars may be.

When you see a qualified plastic surgeon in consultation, you should be able to determine where the scars will be and how much reduction you can expect with a pedicle procedure. It would be very unusual to need a full nipple graft.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
4.8 out of 5 stars 56 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.