Amputation/free nipple graft reduction mammaplasty

Abstract

The amputation/free nipple graft method of reduction mammaplasty is used less frequently than the various pedicled reduction methods. Some valid reservations about this technique are decreased nipple-areola sensation, decreased breast-feeding capacity, diminished nipple erectile response, and the potential for nipple flattening and hypopigmentation. A suboptimal breast shape is another possible drawback. However, amputation and free nipple grafting offers improved safety compared with pedicled reduction mammaplasty, especially for those patients at high anesthetic risk. Some indications for amputation/free nipple grafting include gigantomastia, advanced age, systemic disease with poor microcirculation or poor wound-healing potential (eg, diabetes, chronic steroids, and so forth) and prior breast incisions that may limit pedicle or skin flap viability. Successful implementation of this method requires careful patient selection, and in general, it is not a good choice for those young patients concerned with breast-feeding capacity or nipple-areola sensation. Potential aesthetic liabilities of the amputation/free nipple graft technique can be minimized by attention to details of operative planning and execution. When appropriately used, amputation/free nipple graft reduction mammaplasty provides excellent patient safety and satisfaction.