Gigantomastia Treated with Free Nipple Graft technique, Raleigh, NC

This 59-year-old woman suffered from very large breast size for many years causing neck pain and back pain and grooves in the shoulder area. She wore a size 44G cup bra and wanted to be much smaller down into the C range. She had very large breasts with very long nipple to sternal notch distance making standard reduction techniques more difficult. The patient underwent bilateral anchor pattern breast reduction with initial anticipation of a nipple preserving technique however she had very fatty breasts with poor blood supply so she had conversion to a free nipple graft technique. This is a technique usually reserved for very large breasted women where anticipated weight of resection is well over 1 kg per side. In most breast reductions, attempts at preservation of the nipples based on their natural blood supply called a pedicle, is attempted however when the blood supply is inadequate removal And replacement of the nipple/areola complex as a full-thickness graft is more predictable and will get its new blood supply from the skin of the overlying breast. Patients generally will not maintain sensation to the nipple but in the vast majority of cases, the nipples survive well as grafts and are often indistinguishable from pedicled technique. This patient had over 4 pounds of breast tissue removed per breast and did very well with full survival of her nipple/areola.. With her new smaller figure and increased ability to exercise, she has lost an additional 50 pounds .