What is the Likelihood of Needing a Nipple Graft During Breast Reduction Surgery?

How will this affect the ability to breastfeed in the future? Will sensation be lost in the nipples?

Doctor Answers 12

Free Nipple Graft Used When Required For Extreme Breast Reduction

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Inability to breast feed, loss of sensation, loss of nipple projection, incomplete take of the nipple/areolar graft and other complications can occur with this procedure. In my practice this is a very unusual as even very large breasts can be reduced with other techniques. On the other hand this is a technique that should be considered when it is expected that there is not sufficient blood supply for the nipple and areola survival.

Nipple Grafting During Breast Reduction?

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Thank you for the question.

There is a very  little likelihood  that nipple grafting is a necessary part of breast reduction surgery. This technique may be helpful for patients who are very large and/or ptopic and who are having breast reduction surgery that involves  relatively long distance movement of the nipple/areola  complexes. If the nipple  grafting procedures performed you will not have sensation or be able to breast-feed in the future.

The nipple grafting procedure is usually planned (again based on your anatomy) so please discuss the specifics of your situation with well experienced board-certified plastic surgeons.

I hope this helps.

Nipple Graft In Breast Reduction

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I rarely find the need for free nipple-areolar grafts in performing breast reduction surgery.  The two situations in which I employ this technique are extremely large volume reductions (rarely) and in patients who are unable to stop smoking (often).  This does result in permanent loss of nipple sensation.  It is also very unlikely that you would be able to breastfeed in the future since the connections of the nipple to the milk ducts have been disrupted.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Breast Reduction and Nipple Grafts...

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Under the care of a well trained plastic surgeon, nipple grafts during breast reduction need almost never be done!

With the wide variety of breast reduction techniques now at the disposal of plastic surgeons, reduction methods can virtually always be selected which will allow for safe preservation of natural blood flow to the nipple and areola, eliminating the need for "nipple grafts".

The "inferior pedicle" breast reduction technique has become the "gold standard" when it comes to nipple and areola preservation. Having used that method in my practice over a span of 30+ years, nipple loss following breast reduction has become an extreme rarity, and my use of nipple grafts has been almost non-existent. Furthermore, this method frequently allows for preservation of nipple sensitivity and, occasionally, the subsequent ability to breastfeed.

Charles Gruenwald, MD (retired)
Baton Rouge Plastic Surgeon

Free nipple grafting with reduction

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very rare these days. you didn't offer any information on size but you would have to be enormous and VERY low to require a free graft. if it has been suggested do some more asking. hope this helps.

Sherwood Baxt, MD
Paramus Plastic Surgeon

Nipple grafting is unnecessary

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Nipple grafting is no longer necessary using a new technique in breast reduction surgery. With this technique viability of the nipple areola complex is no longer an issue regardless of breast size. The nipple is never detached from the breast mound so nipple sensitivity is preserved.  Many issues have been resolved with this technique that were  problematic using standard breast reducing procedures (including that of breastfeeding). Great question!

Best wishes,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Questions on free nipple graft fro breast reduction

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A free nipple graft breast reduction is virtually always a pre-planned procedure that is selected for a variety of reasons.When it is selected intraoperatively, it is employed to save the viability of the nipple-areola complex when there is evidence that this tissue would otherwise not survive long term because of blood supply (or removal) issues.

A free nipple graft completely detaches the nipple from its blood and nerve supply. As a consequence, there will ultimately be little sensation and no sensuality.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Nipple graft during breast reduction

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 First of all, what we mean by a nipple graft is that the nipple and surrounding areola are literally cut off from the breast tissue just under it.  This graft is made very thin usually by a scissors:  the nipple part is about the thickness of the nipple but the surrounding areola is thinned so that it is not much thicker than paper. 

For the vast majority of cases, this is not done, and the nipple-areolar complex is carried to a higher level on the chest still connected to the  breast tissue.  But sometimes, the surgeon before surgery has determined that for a  very large reduction when the distance to elevate the nipple is too high, there may not be enough circulation to go all the way  to the nipple, and the nipple would have to be "disconnected"  and replaced as a graft where the tissue has better circulation.

You might wonder how a detached graft can pick up circulation and you would be right.  There is essentially no circulation for a few days until very tiny blood vessels reconnect, so that initially, the cells in the graft are almost dying.  But after about 5 days the graft usually "squeeks" by and survives.

The need for a nipple graft procedure may be determined preoperatively, but very rarely, a surgeon may feel that during the surgery (or even just afterwards), the circulation is inadequate and the surgeon must perform the grafting procedure.

The problems with nipple grafts are that the grafts may not take completely, may not develop sensation over time, and may lose color or become speckled by uneven loss of color. Obviously, the ducts are severed and do not connect so there is no chance of breast feeding.

Joseph Rabson, MD (retired)
Philadelphia Plastic Surgeon

A free nipple graft is always a possibility during breast reduction surgery

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A free nipple graft is not a common occurance but can happen during breast reduction surgery, especially is very large breast reductions or in a breast that is very very droopy (because the pedicle of the blood supply is longer and has to travel further.) 

If the surgeon decides to perform a free  nipple/areola graft during breast reduction surgery, the ability to breast feed will be lost since the ducts are cut.  Sensation may return in time, but more often sensation is reduced or eliminated as well.

Nipple Grafting Used Less Than Ever Now

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  • Nipple grafting is becoming less common in breast reduction surgery I have noted.  This is because other techniques have proven to be successful in preserving the natural nipple without the need for grafting as well as the many varied problems nipple grafting have presented.  Loss of sensation is almost always a part of nipple grafting.  Loss of part of the nipple is also common.  Grafted nipples seldom look natural.

At one time nipple grafting was considered necessary for extremely large breasts but I feel many surgeons now accomplish large breast reductions successfully with intact nipples with sensation.

John K. Long, MD
Houston Plastic Surgeon

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.