Notch to nipple distance of 40cm - will I need a full nipple graft?

Question

Ive had 2 consults for breast reduction. Im currently a 30j, my breasts hang really low and narrow with loss of volume on top. Ive wanted to reduce them forever but both surgoens recommended a full nipple graft because of my sternal notch measurement. Id like to know if I have options besides FNG even if if means I dont go super small. Please help. Thank you

Salvador Medina, MD · Answer

There are many techniques for a breast reduction. I personally have never done a full nipple graft because I think we can lift as much as needed with a specific technique for that.
I would absolutely consider doing a technique that doesn´t involve a full nipple graft.
Every case has to be studied appropriately and decide what technique is best for you.
Feel free to contact us for an evaluation.

Thank you.
Dr. Salvador Medina

Mert Demirel, MD · Answer

A 40 cm sternal notch-to-nipple distance is long, and that is why your surgeons are discussing a free nipple graft. The longer the nipple has to be moved, the more concern there is about blood supply to the nipple during a standard pedicled reduction.
That said, a free nipple graft is not automatically the only option based on one measurement alone. The decision also depends on breast width, tissue quality, smoking status, medical history, how much tissue needs to be removed, nipple-to-fold distance, and how small you want to go.
If you are willing to stay somewhat larger, a pedicled reduction may be possible in selected cases because less tissue removal and less tension may help preserve blood supply. Some surgeons experienced with very large reductions may use inferior, superomedial, or other pedicle techniques even with long measurements.
The trade-off is that avoiding a free nipple graft may limit how small or lifted the breast can safely be. It may also carry a higher risk of nipple blood supply problems if the pedicle is too long or under tension.
My advice would be to get another opinion from a surgeon who regularly performs large breast reductions. Ask specifically whether a pedicled reduction is possible if you accept a moderate reduction rather than going very small. A FNG may still be the safest option, but it is worth confirming with a high-volume reduction surgeon before deciding.

Daniel Barrett, MD · Answer

Dear 30j,

it is hard to tell for sure without an examination. 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

Jonathan Heistein, MD · Answer

The measurement alone is not the only indicator of when a FNG is necessary.  It is not unusual to for women to get a breast reduction and lift without a FNG even with long sternal notch to nipple distance.  Many times it's avoidable.  Hope that helps.

Gary M. Horndeski, MD · Answer

I recommend the Bellesoma. 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 muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. A full nipple graft is not required.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Finny George, MD · Answer

Hi, thank you for sharing your question. Based on that measurement, you are at risk of a FNG but this is not a hard and fast rule. FNG can be avoided in many situations.

Camille Cash, MD · Answer

It's difficult to give a firm answer with this one piece of information.  I encourage you to visit with a few experienced board certified plastic surgeons.  Be sure to express your concerns and talk about options.  Though this measurement is indicative that a FNG may be best, an exam may reveal it's not necessary in your case.

Karl William Schwarz, MD · Answer

I started practice in 2007 and since then I have seen an increase in the number of free nipple grafts (FNG). I am not sure why. When a FNG is done the new nipple tends to be hypo pigmented, flat, insensate, and not look very good.

Here is how I approach patients with very large, long breasts. I explain that I will try to perform a breast reduction as I normally do but if I see there is a problem with the blood supply to the Nipple Areolar Complex (NAC) I will convert them to a FNG. So far I have only had to do that once out of hundreds of cases. In my experience the blood supply is fine even in women with very, very long pendulous breasts (40 cm distances) and having a full NAC that has sensation and looks normal is a much better option than a FNG>

Notch to nipple distance of 40cm - will I need a full nipple graft?

Answers (8)

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