Free Nipple Graft Breast Reduction without a Vertical Incision

Abstract

Background: A technique of a free nipple graft with an inframammary incision and no vertical incision offers promising postoperative results as a safe and aesthetic alternative.

Methods: This was a retrospective chart review of patients who presented to a single surgeon for breast reduction surgery using a free nipple graft with an inframammary incision from June 1999 to March 2021. Baseline patient demographics and clinical information along with postoperative complications were recorded and compared between patients who presented for concomitant reconstruction or just reduction. A narrative literature review on surgical techniques and outcomes was also conducted.

Results: From the literature search, there have been minimal prior mentions of breast reductions using a free nipple graft with an inframammary incision and no vertical incision. Fifty-five cases were identified for breast reduction surgery in the author's 22-year study period, of which 46 had adequate clinical documentation and follow-up. An estimated 22 patients had either both or one breast reconstructed with opposite side breast reduction, and 24 patients underwent breast reduction alone with free nipple grafting. No implants were used in any of the patients.

Conclusions: The free nipple graft technique with an inframammary incision can be performed on patients with excessively large or ptotic breasts. It is possible to reduce the volume of the breast and obtain good projection with this method. Furthermore, avoidance of the vertical incision reduces breakdown at the T-junction and is aesthetically beneficial.

Fig. 1.

Preoperative markings of a 43-year-old female patient with right breast stage 0 carcinoma.

Fig. 2.

Schematic of free nipple skin graft removal.

Fig. 3.

Intraoperative lateral photograph of the de-epithelialized inferior flap.

Fig. 4.

Intraoperative photograph of the superior flap sutured over the de-epithelialized inferior flap.

Fig. 5.

Barbed sutures tightened to create inframammary fold and increase projection.

Fig. 6.

Schematic of the free nipple graft placed over the de-epithelialized area on the superficial flap.

Fig. 7.

Schematic showing the final result.

Fig. 8.

Bolster dressing applied to the free nipple graft after suturing into position.

Fig. 9.

Postoperative photograph of a 43-year-old female patient who presented with right breast stage 0 carcinoma for bilateral breast reduction at 15 months.

Fig. 10.

Images of preoperative and postoperative results utilizing a free nipple graft without a vertical incision. A, Preoperative and B, 4-months postoperative photographs of a 57-year-old female patient who presented for breast reduction surgery.

Fig. 11.

Images of preoperative and postoperative results utilizing a free nipple graft without a vertical incision. A, Preoperative and B, 6-months postoperative photographs of a 61-year-old female patient who presented for breast reduction surgery.

Fig. 12.

Images of preoperative and postoperative results utilizing a free nipple graft without a vertical incision. A, Preoperative and B, 20-months postoperative photographs of a 42-year-old female patient who presented for breast reduction surgery.