Important Information about Free Nipple Graft Breast Reductions

In this procedure the nipple/areola complex is removed quickly and placed on a moist saline sponge. The plastic surgeon removes most of the tissue within the breast, makes a "pocket" with the skin and puts in the amount of breast tissue needed to achieve the final size. The skin is trimmed to fit, shaped around the breast tissue and stitched together. Once the breast is re-formed, the nipple/areola complex is grafted back into place, taking care to try for the best placement to achieve some reconnection of the nerves for reactivity. Then there is a bolster placed over the nipple/areola complex (NAC) to assure continual pressure on the NAC and the best possible chances for reconnection of the blood supply and some nerves. When performed well and with good reconnections, the patient can expect some return of reactivity in the nipple, but no sensual response or ability to breastfeed is likely after the FNG procedure.

The risks of this surgery include: (1) too much breast tissue may be removed for the breast to be shaped properly, which is possible with any breast surgery; (2) the nipple and areola may look unnatural or may not survive the grafting process; (3) the color of the nipple and areola may fade or become uneven (especially in darker-skinned women); (4) the nipple will most likely lose all sensation and may no longer become erect when stimulated; and (5) breast feeding will be impossible because the milk ducts have been drastically rearranged or removed entirely.

Some of the advantages to this surgery are: (1) it can be performed quickly, so time under anesthesia is brief and blood loss is minimal; (2) for very large-breasted women (notch to nipple measurement of over 40 cm or fold to nipple measurement of over 20 cm) it can be extremely difficult to protect the pedicle when there is extensive tissue removal, so reshaping a greatly reduced breast around a pedicle can lead to a disappointing result in terms of the new breast's shape and form, as well as increased chance of nipple loss due to compromised blood supply; (3) A free nipple graft may allow a woman to reach a smaller size than would be possible with a pedicle technique. Conversely, a pedicle technique may be achieved if a woman chooses to be a larger cup size than she originally desired.

Most surgeons tend to avoid using this procedure on younger women and may suggest it for older women, reasoning that nipple sensation is not that important for an older woman. This procedure might be used on a younger woman when the notch to nipple measurement is more than 40 centimeters and/or the fold to nipple measurement is greater than 20 centimeters.

In all the variations of the Pedicle method, the pedicle holding the nipple/areola complex remains intact, and the entire structure is moved into its new location. It is never detached, and sensation and function are typically preserved. There is always a possibility of loss of sensation with any breast reduction, and if there is too much tissue in the pedicle to be able to fit into the new, smaller breast area, the chances of compromising the blood supply altogether and thus losing the nipple completely are significant. That is why in any breast reduction surgery there is a chance that the surgeon will need to perform the FNG procedure to one or both breasts to assure the best possible outcome for breast health.

The pedicle method is the ideal way to do this surgery, as your function and sensation should remain intact. However, there are cases where the breasts are just too large and pendulous and do require FNG. It's usually a notch-to-nipple measurement greater than 40 cm that dictates this, though we know of quite a few ladies who have avoided FNG with measurements like this. We have had several members who have had notch-to-nipple measurements greater than 40 cm have a pedicle technique by traveling out of their area and having their surgery preformed by surgeons with extensive experience in this area. Please check our 'Find a Surgeon' section, and ask on our forums for referrals to surgeons we have found who may be able to perform a pedicle procedure on N2N measurements longer than 40cm

If you are facing free nipple graft, we hope you will let us know so that we can help to guide you through it. You want to be absolutely sure you need a FNG before you proceed. In some cases, having the very best plastic surgeon will allow you to have a pedicle technique instead.

PLEASE NOTE: If you have had a very well done and successful FNG in the past, another doctor may not be able to tell. Should you ever need any sort of additional surgery on your breasts, please be sure to let your surgeon know that you did have a free nipple graft. If your doctor does not know you had free nipple graft, he may assume you had the pedicle method. If this is the case, he may destroy the blood supply to the area your nipples have been re-attached to. In the event this happens, there is a very strong possibility that you could end up having your nipples destroyed and lost during a future surgery. Please share a complete medical history with any future health care provider that you have.

  • Saturday, 16 June 2012