FNG or Not? (Photo)

I do not think that a free nipple graft breast reduction is necessarily old fashioned. But it also is not necessary in almost all cases. I have completed medial pedicle and superior-medial pedicle breast reductions on very long breasts without vascular compromise to the nipples. So I know that it can be done safely without an amputation technique in your case. But, that doesn't mean that it should be done that way with all surgeons. In the end, you should choose a surgeon who gets safe and great aesthetic results. And I think that could be done with a free nipple graft technique with some surgeons who are really good at that technique. You would not want me to do a FNG reduction for you, because I would not do it very well. I just don't use that technique ever which means I would do it poorly. But another surgeon might be really great at it and the results can still be great with the right surgeon. Below is a link to just one of many very long breasts completed with a vertical breast lift technique without requiring a nipple graft.

Thank you for your question and photos. From your words, I think the distance of IMF-to-Nipple is 10 cm. which means you have severe sagging breasts. However, from my experience, I did several similar cases with Vertical-scar technic Breast Reduction. And the result is quite satisfied, you can keep the nipples intact with no nipples/areola loss. So, I advise Vertical-scar Breast Reduction, no FNG need.
Hope this help,Dr.BoonchaiCertified board of plastic and reconstructive surgery (Thailand). Member of International Society of Aesthetic Plastic Surgery (ISAPS). Member of American Society of Plastic Surgeons (ASPS).

I never use free nipple grafting. The technique I recommend is 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 (in 95%) and the ability to breast feed are maintained.

Best Wishes,

Gary Horndeski, M.D.

There is nothing wrong with the fng. However you can easily get a good and safe breast reduction with the standard nipple procedure.

Dear TheSnash,
breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. 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

While it is your option to proceed with a FNG with your reduction, it may not be necessary. I encourage you to visit with a few board certified plastic surgeons near you for consultations to hear varying opinions and recommendations. It is important that you are comfortable and confident in your surgical plan.

Maintaining blood supply to the nipple areolar complex during a breast reduction is one of the biggest priorities in the procedure. When there’s a chance that the blood vessels may not be able to be preserved, especially in patients with very large breasts and long stretched out blood vessels, patients will need to be counseled on the possibility of a full thickness nipple graft during the procedure should the blood supply look inadequate to support the nipple in surgery. There are, however, multiple blood vessels which supply the NAC and thus multiple pedicles can be utilized during a breast reduction (the ‘pedicle’ is the tissue between the nipple and the chest wall that contains the blood vessels and nerves). While sternal notch to nipple distance is important in determining the potential risk for loss of blood supply to the nipple, there is no hard and fast cutoff of centimeters to say, with certainty, whether a full thickness nipple graft will be necessary or not. Based on the pictures that you submitted, I would recommend a second opinion. Your degree of macromastia, in my opinion, would not guarantee the need for a graft. Additionally, I rarely make the decision ahead of time to move forward and commit to a free nipple graft. With your size and measurements, I think this decision is best made intraoperatively.