Free Nipple Graft vs. Pedicle method?

Question

Hi! I'm 26 y/o with 36J breasts. I've had a consultation with a surgeon, who said it'd be almost impossible to do the pedicle method, and he recommended a FNG due to my fold-to-nipple measurement being at 12 cm. Any thoughts about the advantages/disadvantages to both techniques? is my pedicle too long to try moving it up? Is it possible to ever regain nerve sensation in the nipple after getting a FNG? Thank you in advance!

John Mancoll, MD · Answer

Thanks for your question. It has been over 15 years and 1000 or more reductions since I have had to do a fng. For me 12 cm is not enough length to consider a fng. There are other facts that I consider but it is a very unusual case were I have a discussion about this anymore. In plastic surgery we are all victims of our training and since there are multiple techniques to doing a BBR then maybe consider another opinion or two. Good luck.

Leland Deane, MD, FACS · Answer

In my experience free nipple graft techniques are rarely done anymore, except for extreme breast sizes. Best of luck.

Reza Momeni, MD, FACS · Answer

You not given us enough information nor heavy given us any photographs to be able to truly answer questions.  Generally, nipple graft operations are considered inferior to a pedicled operation, because patients with a nipple graft will lose feeling and ability to breast feed.  Therefore, the nipple graft operations is it is almost never the 1st choice for a surgeon and patient.  If however, you're not a candidate for the pedicle operation, then your simply not a candidate for the pedicle operation and does not involve the choice.  The only choice in that scenario would be not to have breast reduction.

Jeremy S. Hurren, BSc, MBBS, FRCS (Plast) · Answer

I almost never to do FNG except where there  has been previous surgery which compromises the pedicle. Even then I might make the decision during surgery. So I would do the FNG if when I raised the pedicle the nipple blood supply looked suspect.12cm pedicle length would not necessarily cause me to go for a FNG.Pedicled nipples tend to look more natural and heal better (unless they do not survive!). Pedicle are more likely to retain sensation and possibly breast feeding potential.I would nearly always use a pedicle if I can.However as always you need to be assessed by a suitably qualified and experienced surgeon to get the best advice.

Steven Wallach, MD · Answer

If your distance is only 12 cm's from the fold, then it should be possible to perform a pedicle reduction. An exam in person is key. Best of luck.

Jeffrey Antimarino, MD, FACS · Answer

Thank you for your question.Without  a physical exam it is hard to say definitely which would be best for you.   If the fold to nipple distance is only 12 cm then a pedicled reduction should work well.   There are other measurements that would be helpful to determine as well such as the sternal notch to nipple distance.I have performed many reductions for ladies with breasts as large as yours and larger using the pedicle technique and without using a free nipple graft with good results.    I try to avoid the free nipple graft as much as possible due to loss of sensation and scarring but it may be necessary in a small number of cases.A surgeon does not have to commit to a free nipple graft until the end of the procedure so the whole surgery can be done as a pedicle technique and  the nipple graft only done  if necessary.

Rick Rosen, MD · Answer

An examination would be necessary for accurate advice. But if you truthfully are that large, then a free nipple graft may be safer to preserve the blood supply to the nipple. Once over 1200-1500 gram reduction, it should be considered. You will get some sensation back, but not the same, and you can not breast feed afterwards. I would get another consultation to confirm your concerns.

Zachary Farris, MD, FACS · Answer

Thank you for your question.  In my practice, I've performed many breast reductions on some incredibly large breasts (way beyond your measurement) and I've never had to do a free nipple graft luckily.  It's always an option but I personally would not like to jump to it first.  Be sure to consult with several different board certified plastic surgeons to get a better idea on your prospects.  Good luck!

Rahim Nazerali, MD · Answer

Thank you for your question. FNG vs. pedicled nipples are based on not only the distance from the IMF to the nipple but as well the technique used by the plastic surgeon. There are a variety of factors that contribute to the decision as to whether a free nipple graft may be necessary during a breast reduction including nipple to fold distance, skin envelope, skin quality, tissue density, etc. Only an individualized consult with a board certified plastic surgeon will help determine what is right for you. I will always to attempt keeping the nipple pedicled to maintain nipple sensation, innervation and coloration however, rarely the nipple may not be viable. In those situations I revert to a free nipple graft. Of course, I always have a discussion with my patient preoperatively that this may be a possibility if I am concerned.

Free Nipple Graft vs. Pedicle method?

Answers (9)

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