What the technique is
In a full-thickness nipple graft, also called a free nipple graft, the nipple and areola are removed completely from the breast, the breast is reshaped, and the nipple-areola is then placed back as a skin graft in a new position. Because it is detached, it has to grow a new blood supply from the tissue beneath it.
Why it is not Dr. Jaberi's first choice
The alternative is to keep the nipple on a pedicle, a stalk of breast tissue that carries its blood supply and, often, its nerves and milk ducts. This usually preserves sensation, may preserve the ability to breastfeed, and gives the nipple a more reliable blood supply. A free graft gives up these advantages.
- Sensation is commonly reduced or lost
- Breastfeeding is generally not possible afterward
- The nipple may lose pigment or projection, or look flat
- There is a risk the graft does not fully take, partly or completely
When it is the right choice
There are situations in which the pedicle approach is not safe. In a very large reduction, the distance the nipple would have to travel on a pedicle can be too long, and the blood supply could be compromised. In people with significant risk factors for poor healing, or with certain anatomy, a graft can be the safer way to protect the breast and nipple.
When the choice is between a pedicle that may fail and a graft that is reliable, safety wins. It should be a decision made together, with the trade-offs explained clearly, before surgery.
What you should ask
Ask whether a pedicle technique is possible for you, what makes a graft necessary, and what you will lose or keep either way. This is part of every large reduction consultation.