“Immediate Free Nipple Grafting with Autologous Breast Reconstruction for Large and/or Ptotic Breasts: Preserving the “Nipple-Sparing” Option”

BACKGROUND: Free nipple grafting (FNG) has been long reported as a viable alternative for aesthetic results and patient satisfaction in the setting of reduction mammaplasty in severe macromastia. This study demonstrates that FNG concepts used for reduction mammaplasty can be applied to autologous reconstruction following mastectomies in patients who do not qualify for traditional nipple sparing mastectomies. METHODS: A retrospective chart review was performed at two institutions for patients who underwent immediate autologous breast reconstruction with simultaneous FNG by the senior author (K.M.P.). Patient information collected included age, gender, BMI, and follow-up time. Recorded outcomes included nipple survival, depigmentation, revision and post-surgical complications. RESULTS: A total of 45 patients underwent a total of 73 nipple grafts. The population mean age, BMI and follow-up were 52.7 years, 28.8 kg/m 2 and 359.81 days respectively. 39 patients (60 breasts) underwent autologous breast reconstruction using deep inferior epigastric perforator (DIEP) flap (18 unilateral, 42 bilateral). 1 patient underwent right-sided DIEP with contralateral TRAM flap, and 1 patient underwent bilateral pedicled latissimus dorsi flaps.100% of nipple grafts survived with no NAC graft or breast flap loss. 15 patients experienced minor postoperative complications including 7 patients with partial thickness graft necrosis. 3 patients with 4 FNGs demonstrated depigmentation. 4 patients requested additional revision. CONCLUSIONS: FNG offers a viable alternative alongside reconstruction as it preserves a natural NAC appearance compared to nipple reconstruction with or without tattooing. While FNG limitations persist, it remains a safe and cosmetically beneficial option for patients with limited nipple preservation choices.