Free nipple grafts – what are they?

Free nipple grafts are a slightly old-fashioned breast reduction technique in which the nipple is completely removed from the breast and replaced as a skin graft.

Free nipple grafts were used some years ago because they were believed to be a safer technique in performing very large breast reductions of 1 kilogram and over per side.

The reason a nipple graft technique was considered safe is that no pedicle (the bridge of tissue which supplies blood to the nipple) was required. Surgeons felt that the blood supply to the nipple in very large breast reductions, because the pedicle will need to be very long, might be jeopardized towards its tip.

Therefore, they were concerned that the nipple at the end of the pedicle may have problems with its blood supply as did occur in some breast reduction procedures in the past.

The advantage of free nipple grafts is that they are relatively straightforward and quick to perform from the surgeon’s point of view. The downside of this technique for the patient is that the scarring around the nipple can often be very unattractive.

This is because the nipple will take as a skin graft and may be very patchy, leading to different areas of pigmentation and scarring within the nipple.

The other main disadvantage is that the nipple will remain numb with normally very little sensation as it has been completely detached from the body, dividing its nerve attachments.

Generally, free nipple graft breast reduction techniques are now rarely used in the United Kingdom at present. With the advancing new pedicle techniques which are more reliable such as the inferior and supramedial techniques breast reductions keeping the blood supply to the nipple intact are becoming much more common and in our opinion gives the best results following surgery.