Free Nipple Grafts: What to Expect During the Healing Process

Abstract

A variety of surgical techniques for masculinizing chest wall reconstruction has been described. One well-described approach is the double incision subcutaneous mastectomy with free nipple grafts. There is little documentation available that clearly describes the healing process of free nipple grafts for patients and their caregivers. The nipple-areolar complex is harvested as a full-thickness skin graft. It is resized and repositioned to conform to a more masculine aesthetic. A bolster of nonadherent dressing is tied over the graft and left in position for 7 days as adherence, imbibition, and inosculation occur. The superficial layer of epidermis of the graft initially exfoliates as it is replaced by upwardly migrating cells of follicular epithelium. This is observed as a sloughing which can be disturbing to the patient although it is an expected progression of the healing process. Viable pink dermis will be seen underneath. Pigmentation of the nipple graft can take 3-9 months. Free nipple grafts are useful in cosmetic and reconstructive surgery of the breast. Additional documentation of the healing process provided here can help reassure the patient and their primary care providers.