Breast Reduction #147

A mother of 1 who is a 40G-H cup and has had problems with shoulder pain and irritation of her shoulders from her bra straps.  She also has back pain and difficulty with her posture.  Her case is complicated by a history of pack-a-day smoking in the past as well as a relatively long distance from the breast fold to the nipples.  This places her at high risk for fat necrosis and tissue loss from a traditional inferior pedicle technique.  Although she is no longer smoking, her significant history of smoking has damaged the small blood vessels that need to supply blood flow to the nipple at the end of the “pedicle” or strip of tissue carrying the nipple.  This tissue can “die” and turn black and the fat can lose its blood supply and get very lumpy like a bar of soap.  In these cases, it is safer to use a free nipple graft technique.  The nipple is removed completely and put back on as a free graft, like a skin graft.  It can look scabby in the first 6=-8 weeks and the areola frequently loses some of its pigmentation.  But the pigment improves over the following two years and the breasts typically stay soft and heal relatively well-allowing us to perform a much-needed breast reduction in some patients who otherwise would not be good candidates.

She is shown before and again, 2 years after a free nipple graft breast reduction with the removal of 1091 grams from her right and 1207 grams from her left.  (454 grams = 1 pound)

Her symptoms have resolved, and she is pleased with her shape and size.  The breasts remain soft.  The areolas have lost some pigment as is typical but her overall result is good.