Surgeon Says I Need Free Nipple Grafting for my Breast Reduction?

I'm 5'2, 159 lbs, 46F. I seen a surgeon today and he said I would need a Free Nipple Graft & there was no other options! He said I have "long" breasts and my nipples are positioned far down. I'm stumped because I do want to breastfeed or "try" to and I feel like there's no other option and if there is what is it? My insurance is from the state, so they want a nice size removed, but how much should I get removed and what's an alternative. My back, neck, and body can't take these breasts anymore

Doctor Answers 8

Seek a second opinion

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Thank you for your question,

Free nipple grafting should be reserved for extreme cases and should
not be a first option for you. Especially since you are planning on
breast feeding in the future. I would highly recommend seeking another
opinion from a board certified plastic surgeon.

Good luck!

Dr. Sam Speron

Chicago Plastic Surgeon

Seek one or two additional opinions before having your surgery

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Even with the measurements you have provided without at least a photo or better yet a hands on exam it is impossible to agree or disagree with your surgeons opinion. However, from your measurements I would say that the safest form of breast reduction may very well require a free nipple graft approach. My advice would be to seek out one or two additional board certified plastic surgeons for an opinion before you make a final decision. If you are willing to accept perhaps less of a reduction you might be available to avoid a free nipple graft.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

Breast reduction - do you need free nipple grafts?

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Surgeons worry that if the nipple is too low, that the blood supply will be cut during the surgery. This starts to concern surgeons when the clavicle to nipple distance gets over 35cm or so. This is especially true with older "inferior pole" techniques, which leave the nipple attached to tissue at the bottom of the breast only. Find a surgeon that uses superior/medial pole technique, where the blood flow is preserved from the large sternal perforators. With this technique, the nipple rarely needs to be "grafted", as the blood flow to the tissue is inherently better. The final decision can be made at the time of surgery, ultimately if you keep getting that answer then it may not be safe.

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Breast reduction without free nipple grafts

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Breast reduction with free nipple grafts are to be reserved for extreme cases of size and elevation distance. This is extremely rare in my opinion. There are ways to at the very least attempt to save the nipple areolar complex. I would recommend you seek more than one opinion from board certified plastic surgeons who have experience with large breast reductions.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 115 reviews

Free nipple grafts usually not needed in breast reduction

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While there are guidelines for when free nipple grafting is indicated, in women still considering breastfeeding I think the those guidelines can be pushed somewhat.  While 46F is large it does not seem so large as to absolutely require free nipple grafting.  I would get other opinions prior to aggreeing to free nipple grafts. 

Jeffrey Thaxton, MD
Charleston Plastic Surgeon

Free nipple grafting

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In cases of large breasts (F-G+) and extremely pendulous breasts, free nipple grafting is generally required. Without this, the risk of nipple necrosis is extremely high. I personally would not try to preserve nipples at a patient's request when I know that it is medically inappropriate to do so. If you feel that your symptoms require breast reduction at this time, then the consequences of the procedure are things that you must consider in making the decision for surgery.

Concerns about Breast Reduction Consultation?

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Based on your description, it sounds like you may be an excellent candidate for breast reduction surgery. Generally speaking, it is a good idea to seek consultation with a few carefully selected, well experienced board-certified plastic surgeons. If you find that there is a consensus in their recommendations, it is likely that you will feel more comfortable proceeding. Of course, you will have to weigh the pros/cons of having the procedure performed. Also, you will need to consider timing of the procedure in relation to life circumstances (such as pregnancy, breast-feeding…).

 Again, seeking additional consultations may be helpful to you.

Best wishes.

Alternatives to Free Nipple Grafting Breast Reduction

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In long heavy low hanging breasts, free nipple grafting is an option if you want the maximal reduction. But it is not absolutely necessary in breasts like yours if you can live with a little bit less reduction and lift. Since you are younger and want to breastfeed later then this is not a breast reduction technique for you. I would visit other plastic surgeons and get their opinions. It is very likely your next consult may recommend an alternative breast reduction procedure where the nipples are not removed and replaced as skin grafts.

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.