American Society of Plastic Surgeons
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Valeria
2 years ago
Answered

Brea

I am being told by my Dr after my visit that he can only do a complete nipple grafting on me because of the size of my breast. Mentally i wasn't looking forward to this method because i wished to retain some probability of breastfeeding. Please do i have other options? Been feeling so depressed about this. Please any advice?

Procedure: Breast Reduction
Type: Question

Replies 11

Jonathan Amspacher
ASPS Surgeon

Hi Brea, I would take the time to consult with another plastic surgeon or two before deciding to go forward with surgery. Many of us do very large reductions without doing nipple grafts. Breast reduction is a surgery that has a lot of different techniques to treat the same problem. You may want to get several opinions before proceeding. However if breast feeding is really important to you then you may want to wait until you’re done having children. This is because even with techniques that don’t remove the nipple your chances of successfully breast feeding are reduced to about 30% in some older studies. Best of luck on your journey.

Dr. Amspacher

Director of Plastic Surgery Mosaic Life Care

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Shashidhar Kusuma
ASPS Surgeon
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I would agree with Dr.Amspacher. In most cases, reductions can be done without nipple grafting. In the extreme cases and outlier cases, that maybe necessary, but even in those cases, it is worthwhile to get a few opinions and attempt a reduction without grafting.

'Wish you well.

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Steven Wallach
ASPS Surgeon
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It is difficult to say without an exam. Very large and long process sometimes require a free nipple graft procedure. In those cases patients are on able to breast-feed after surgery. However many many patients can undergo a pedicled breast reduction which will allow them to breast-feed. I could only tell by seeing you in person.

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Debra Johnson
ASPS Surgeon
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I always perform breast reductions with the goal of preserving nipple viability and sensibility along with the ability to breastfeed. However, women with very large or very droopy breasts I always warn that I may have to free nipple graft if the nipple doesn't look "happy" towards the end of the procedure. That being said, I can't remember the last time I had to do a free nipple graft.

You may want to wait until after you have finished childbearing before undergoing breast reduction. Pregnancy and breast feeding can change the size and shape of the breasts, so delaying reduction would give you the longest lasting result. Younger women who have not had children may not be willing to wait if their large breasts are making them miserable, but realize there may be some "maintenance work" necessary after having your kids.

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Mark Deutsch
ASPS Surgeon

Thank you for your question, it is difficult to answer without seeing a picture. In patients with very large breasts the nipple does need to be grafted but it is much more common that we can perform a breast reduction with a pedicle designed to keep the nipple viable. It is best that you consult with several plastic surgeons and decide who you feel comfortable with to do your surgery. Best of luck to you!

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Jon Ver Halen
ASPS Surgeon
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Dear Brea,

I suggest that you seek a second opinion, if you are concerned about the free nipple graft. It is not possible to give you a good recommendation without an in-person evaluation, but I suspect that you are likely a candidate for a different procedure. Good luck!

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Michael Cohen
ASPS Surgeon

Brea,

It is difficult to say exactly without examining you whether a free nipple graft reduction is necessary in your case. If you are not happy with one surgeon's plan, definitely seek a second opinion from a different plastic surgeon. Make sure he is (1) certified by the American Board of Plastic Surgery and (2) has extensive experience in plastic surgery of the breast. Good luck.

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Jonathan Zelken
ASPS Surgeon
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I agree with all of the above. First thing's first, please obtain a second opinion by an ASPS member surgeon. I reserve free nipple grafting for salvage only and will always attempt to spare the nipple if possible. Having said that, there is a chance even with nipple preservation that your capacity to breast feed may be affected after surgery. Other methods like weight loss, support bras, and physical therapy may allow you to postpone surgery for a while. Hope this helps!

Dr Zelken

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Jason Petrungaro
ASPS Surgeon
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My advice is to seek another opinion. Make sure your Plastic Surgeon is board certified by the American Board of Plastic Surgery. Like many of the other surgeons who have answered your question, I can't remember the last time I had to perform free nipple grafts on a breast reduction. It has been years since I have done it. I always go into a breast reduction with the intention of preserving the nipples. If by the end of the surgery the blood supply looks really poor to the nipple(s), only then will I entertain the need for this. My other advice is to consider waiting to have your breast reduction until after your childbearing. I say this because breast reduction surgery will often reduce or even eliminate the ability to breastfeed (we are removing almost 1/2 of your milk producing tissue). And you are correct, free nipple grafts will 100% prevent you from breastfeeding. Best wishes!

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Richard Peinert
ASPS Surgeon

Strongly agree re second opinion. Almost never necessary to do free nipple graft.

If future breast feeding real important, consider waiting until you have children. In my practice about half the women after reduction have breast fed, but with free nipple graft you will not be able to breast feed.

You can go to plasticsurgery.org to find a board certified plastic surgeon in your area.

Good luck.

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Steve Vu
ASPS Surgeon
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I agree with the opinion of the other experts regarding this question. For women with extremely large breasts, I will mention the possibility of a free nipple graft during my consultation but the reality is that my only nipple graft was over 15 years ago. I also agree that you should wait until you've had your children if breast feeding is really important. An uncomplicated breast reduction procedure may still reduce your ability to breast feed.

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