When does your surgeon locate the new position of the NAC? Before or during your Breast Reduction?

Do surgeons locate the new position of the NAC before surgery or during breast reduction surgery? When preforming a wise pattern inferior pedicle breast reduction in general, when do you locate the NAC, with the patient before surgery, or at the end of surgery? Is it waste of time to try and plan the new position of the NAC, since most surgeons don't really know where it will be until the end of the surgery?

Doctor Answers 6

NAC positioning

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Each surgeon will have a technique that they use to locate the final NAC position. There is no right or wrong way to do so as long as the end result achieved looks right. Almost all surgeons will mark the location preoperatively. But some do not commit to the marking until well into the procedure. Others trust the pre-op markings completely and commit immediately. The preoperatively plan is quite important regardless of the technique utilized. 

Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 90 reviews

When is Nipple Position Decided

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There is no absolute answer. Some surgeons mark beforehand and follow them almost every time. Some mark the vicinity and allow for alterations based on things in the operating room. Most, I would guess, make some sort of check in the operating room to make sure that they are in the right place before absolutely committing to a particular height or location.  In other words, the art of the process happens in the OR but the science guides the process preoperatively.

Dr. Pyle

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 125 reviews

Ideal NAC position

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The ideal position of the nipple areola complex is halfway between the shoulder and elbow. Unfortunately, the Wise pattern does not allow you to select that. The nipple is placed where it lies after breast repositioning is done. This is one of the many disadvantages of the Wise pattern. Other disadvantages are nipple numbness, inability to breast feed and the ugly vertical scars. For that reason, a new technique was developed called The Ultimate Breast ReductionTM. This technique avoids the ugly vertical scars, maintains nipple sensation and the ability to breast feed. The nipple is repositioned halfway between the shoulder and the elbow, the breasts are reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. The breasts can be reduced to the size desired by the patient rather than excessive reduction to meet insurance criteria. The Ultimate Breast ReductionTM transfers the weight of the breast to the underlying muscle resulting in immediate pain relief.

Best Wishes,

Gary Horndeski, M.D.

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


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Thank you for your question. Usually, the breasts are marked with the patient awake, sitting or standing upright, prior to the procedure. Markings include the position of the NAC. However, all surgeons are different, so I would discuss this with the plastic surgeon you choose prior to the procedure to better understand his method.

Good luck!

When does your surgeon locate the new position of the NAC? Before or during your Breast Reduction?

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In all aspects of plastic surgery procedures, there may be different  methods that different plastic surgeons utilize. In my practice, and most plastic surgeons' practices I know, breast reduction pre operative markings allow for measurements and planning/positioning of the nipple/areola complexes. Best to run this question by your chosen plastic surgeon for accurate/relevant information. Best wishes.

Nipple Location With Breast Reduction

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I always mark my reduction patients pre-op based on where I would like to see the NAC post-op.  The final determination is made during the procedure, but any difference is usually very slight and the pre-op marking is important.

John Whitt, MD (retired)
Louisville 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.