Large breasts that hang are almost always associated with neck, back, and shoulder discomfort. The key sign that breasts are too heavy and are a source of discomfort and posture problems is shoulder grooving…bra straps lines that have indented the shoulder tissues due to the weight of the breasts that they must support. Breast reduction surgery is extraordinarily effective at improving these symptoms, almost regardless of the amount of breast tissue removed.
One of the primary objectives of any form of breast reduction surgery is preservation of the nipple-areolar complex. While the inferior pedicle technique still remains the most common type of breast reduction performed in the United States, other variations exist. But no matter how the breast mound is reduced, maintaining a blood supply to its only functioning element is how these operations are designed.
In breasts of extreme size, however, concern always arises about how a lot of breast tissue removal may affect the survival of the nipple. (interfere with the blood vessels feeding it) Loss of a nipple due to necrosis after breast reduction is a known risk… but knowing that it can happen and then having it happen to you doesn’t make you feel any better. While there is no exact way to predict whether a nipple will or will not survive after breast reduction, suffice it to say that the larger the breast reduction the greater the potential risk.
One way to circumvent this issue is to consider having free nipple grafts done. While many patients assume that the nipples are taken off and put back at the end of the operation (as a skin graft), this approach is uncommonly done. But in very large breasts, or in those patients that want maximal breast reduction, free nipple grafting may be a reasonable option. With this approach, the breast can be removed to any size and usually even better shaped. The nipples, which were initially taken off at the beginning of the procedure, are then put back on at the end. As a full-thickness skin graft, they have special dressings (bolsters) that must stay in place for a week to ten days after surgery to ensure that the grafts take.
By doing free nipple grafts, however, you are accepting several trade-offs. The ‘new’ nipples will not have feeling, erectile capability, or be able to breast feed. In essence, they are decorations for the breast but will have no function. This is why for younger patients, a smaller breast reduction but with functioning nipples may be a better choice. Also, the nipples may lose some pigment or color. This should be particularly noted in darker pigmented females where this color loss will be more apparent.
Breast reduction with free nipple grafting is an option for those women who have very large breasts that are not concerned with how the nipple functions. Whether this is a good variation for any woman’s breast reduction must be considered on an individual basis. In my Indianapolis plastic surgery practice in the past several years, I am seeing more women than I can ever remember that are choosing this option.
Dr. Barry Eppley
Indianapolis, Indiana