Why Is My Nipple Flat After My Breast Reduction?

Q:  I had a free nipple graft breast reduction almost 6 months ago, and I want a 2nd opinion. The surgery went well, but I don’t have an actual nipple. I only have the areola part. Is that normal? There is no nipple at all. It is just flat… That is why I am concerned. Also, what will happen when I get pregnant? Will milk leak out, or will it not even produce since it starts before baby is born. Is there any info you can give me about pregnancy after free nipple graft. Thank you.

A: In a traditional breast reduction, the nipple is left attached to the central mound of the remaining breast tissue. While the nipple and areolar complex will survive, it is possible to have loss of nipple projection and/or erection. This may occur after this type of breast reduction as the nerves that supply the nipple may not fully function afterwards. This is uncommon however and may not be seen at all.

If you had a breast reduction in which the technique used was a free nipple graft, then you will not only have no feeling, no nipple projection and no ability to produce milk. When the nipple-areolar complex is removed and then applied as a free graft (like a skin graft), there are some predictable outcomes. Most such free nipple grafts actually have the surrounding areola survive but the nipple, which is thicker, usually dies completely and is just replaced with scar tissue. This makes it flat and often lighter in color than the surrounding areola, which is the opposite normal color arrangement.

Dr. Barry Eppley

Indianapolis, Indiana