Breast Reduction Surgery and a Free Nipple Graft


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Dependent on how large a woman’s breasts are will determine which type of breast reduction surgery is recommended. It is imperative that a woman seeks a Board Certified Plastic Surgeon that specializes in breast surgery. The surgeon will be able to help her determine which procedure will give her the results she desires.

Women with extremely large breasts are divided into two groups, gigantomastia and macromastia. Gigantomastia is where more than 1500 grams needs to be removed from each breast and macromastia refer to women that need just less 1500 grams removed from each breast during breast reduction surgery, also known as a reduction mammoplasty.


Dr. Delgado explains to his breast reduction patients that when such a large amount of tissue needs to be removed it may be necessary to perform a free nipple graft. A free nipple graft (FNG) is when the nipple areola complex is completely removed and transposed without a blood supply, skin and glandular pedicle.

The pedicle method is the preferred method for breast reduction; this is where the nipple areola complex remains intact and is moved higher on the breast mound, typically preserving sensation and function. However, a woman with gigantomastia and many with macromastia will be limited to how much the breast can be reduced. It is very difficult to protect the pedicle when large amounts of breast tissue are removed. Shaping a breast around a pedicle is very challenging, and the resulting shape may be disappointing.

Risks of the Free Nipple Graft

Some of the risks with a free nipple graft are:
• The graft might not look natural
• The color of the nipple areola complex may fade
• Loss of the ability to breast feed
• The graft might not survive
• Probable loss of sensation

Dr. Delgado has observed that some of his patients have regained sensation, but it could take up to six months. As far as the viability of the graft, he states his results have been excellent. In some cases they may have partial take but less than 1 percent loss.

As a guideline, a woman who has over 20 cm from the inframmary fold to the nipple may be a candidate for the free nipple graft. Older women seem less concerned about loss of nipple sensitivity and will opt for the FNG in order to have a smaller size. This is a highly individualized procedure where an expert breast reduction surgeon needs to be consulted. Patient input is very important for the surgeon to help guide her in the right direction.

Dr. Delgado, a breast surgery specialist since 1989, has been performing breast reduction surgery for both men and women. The procedure for breast reduction for men is referred to as gynecomastia. Anyone suffering from large breasts is invited to call (415 898-4161) or email (, for more information or to schedule a personal consultation.

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Dr. Miguel Delgado


Dr. Delgado, MD is a world-recognized plastic surgeon and specialist in the treatment of male breast enlargement, also called gynecomastia. He has developed new techniques and owns and operates, which has become the largest gynecomastia forum in the world. Dr. Delgado holds the two most coveted credentials; the certification by the American Board of Plastic Surgery and membership in the American Society of Plastic Surgery.

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