- Pedicle reduction. This is the most common type performed. In a pedicle reduction, the nipple is left attached to the breast, and its blood flow is supplied by the underlying tissue (the pedicle).
- Free nipple reduction. In a free nipple reduction, the nipple is actually removed from the breast and reattached as a skin graft.
Removing the nipple seems like a pretty drastic step, right? And it does completely remove the ability to breast feed, as all of the milk ducts are divided. So why do it? It’s a matter of blood flow. A nipple placed as a skin graft has a lower metabolic requirement (i.e. needs less oxygen and fewer nutrients) than a nipple which remains attached. So free-nipple reductions are done in cases where blood flow to the nipple might be decreased such as:
- Patients with diabetes.
- Patients with a heavy smoking history.
- Very large breasts – in this instance the blood has to travel a long distance to reach the nipple.
But what do your breasts actually look like after a free nipple reduction? For the first week there will be a dressing over the nipple which is held on with stitches. This dressing is called a bolster, and it holds the nipple flat to the underlying tissue both to allow nutrients to diffuse into the nipple and for new blood vessels to grow into the graft.
After the dressing comes off, the nipple may undergo some superficial sloughing, which is when the outer layers of skin peel and flake off. This happens because nipples are fairly thick, and the very outer layers of skin do not get good blood flow initially. This superficial sloughing may result in some irregular pigmentation, especially in darker skinned individuals.
As the nipple graft heals over the ensuing weeks and months, the pigmentation returns. New cutaneous (skin) nerves may also grow into the graft, returning a little bit of sensation to the area. After a year of healing, the nipple graft looks very much like the nipple after a pedicle reduction, although some irregular pigmentation may persist.
Do you have any questions about free nipple grafts? Leave them in the comments and I’ll get back to you.