Free Nipple Graft: What it is and Do You Need it?

The information in this section is made available through the generous support of Dr. Grant Stevens.

Free Nipple Graft: What it is and Do You Need it?

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. 

The risks of this surgery include:

(1) too much breast tissue may be removed for the breast to be shaped properly.

(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 (especially in darker-skinned women).

(4) the nipple will most likely lose all sensation and no longer become erect when stimulated.

(5) breast feeding will be impossible because the milk ducts have been severed, 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.

(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, but this is a very individual thing and the patients input on this is important.

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 whole nipple/areola complex remains intact, and the entire structure is moved into place. It is never detached and sensation and function are typically preserved. 

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 40cm that dictates this, though we know of quite a few ladies who have avoided FNG with measurements above 40.

We have had many members who have had notch-to-nipple measurements greater than 40cm have a pedicle technique by traveling to see Dr. Grant Stevens in Marina del Rey, CA, or Dr. Jennifer Harrington of St. Paul, MN. and there are other great surgeons.

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

For further information, you can learn more about notch-to-nipple and fold to nipple measurements and how they are done at our Notch-to-Nipple Measurement FAQ.

PLEASE NOTE: If you have had a very good FNG, another doctor may not be able to tell. Should you ever need any sort of additional surgery on your breasts, please make 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 well 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.

  • Friday, 23 March 2012