It is accepted surgical practice to routinely consider nipple grafting in very large reduction mammaplasties. Our experience has proved this is not justified. We have achieved complete nipple survival in 90 consecutive large reduction mammaplasties, which suggests that nipple grafting is rarely needed.

Methods:

Ninety patients underwent reduction mammaplasty. An extended inferior pedicle breast flap with a broad chest wall attachment was used. Between 1500 and 4800 grams of tissue were removed per breast. Skin closure was achieved by the “keyhole,” (Lexer) pattern or the “no vertical scar,” (Passot) pattern.

Results:

Nipple shape, projection, and erectile function, were good or excellent with only a few exceptions. There was no change in nipple pigmentation, and no loss of the nipple-areola complex skin. Complications included infrequent hematomas, seromas, and infections. There were no instances of breast skin loss or major failures. The only area of patient dissatisfaction was scarring.

Conclusions:

It is well recognized that when nipple flaps survive, the results are superior to nipple grafts. The extended inferior pedicle method can be routinely used in any size breast. This method is reproducible and can be applied to any reduction mammaplasty, with expected survival of the nipple.
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