Aesthetic Plastic Surgery

, Volume 32, Issue 4, pp 675–680 | Cite as

A New Application for Increasing Breast Projection in Free-Nipple-Graft Reduction Mammaplasty

  • Tonguç IskenEmail author
  • Cenk Sen
  • Murat Onyedi
  • Hakkı Izmirli
Innovative Technique



Free-nipple-graft reduction mammaplasty is the procedure of choice in patients with massive breast hypertrophy. Breasts that have undergone free-nipple-graft reduction mammaplasty usually cannot maintain projection. Many modifications of free-nipple-graft reduction mammaplasty have been described to treatment this problem. We describe our modification of the free-nipple-graft reduction mammaplasty.


The technique includes two key points: The first is the fold of the midportions of the breast. The second is suturing the midportion of the breast to the fascia of the pectoral muscle. The fold increases breast projection and the suturing helps to obtain long-lasting breast projection.


A total of 16 patients underwent free-nipple-graft reduction with the modified technique between 2003 and 2008. Mean follow-up was 21 months (range = 3-60 months). An average of 2016 g of tissue per breast was excised (range = 1250-2700 g per breast). An average of 4031 g of tissue per patient was excised. All patients had long-lasting, pronounced breast mound projection. Satisfactory breast projection was maintained. No “bottoming out” was seen. The level of satisfaction felt by all patients was very high.


Long-term projection can be maintained by suturing the half-trianges to each other and to the fascia of the pectoral muscle. One more useful alternative technique for increasing projection in free-nipple-graft reduction has been added with the technique presented.


Breast Mammoplasty Reduction Nipple-areola Projection 

Supplementary material

(MPG 10322 kb)

(MPG 10690 kb)


  1. 1.
    McGregor JC, Hafeez A (2006) Is there still a place for free nipple areolar grafting in breast reduction surgery? A review of cases over a three year period. J Plast Reconstr Aesthet Surg 59:213–218; discussion 219–220PubMedCrossRefGoogle Scholar
  2. 2.
    Thorek M (1922) Possibilities in the reconstruction of the human form. N Y Med J 116:572Google Scholar
  3. 3.
    Abramson DL (1999) Increasing projection in patients undergoing free nipple graft reduction mammoplasty. Aesthetic Plast Surg 23:282–284PubMedCrossRefGoogle Scholar
  4. 4.
    Gorgu M, Ayhan M, Aytug Z, Aksungur E, Demirdover C (2007) Maximizing breast projection with combined free nipple graft reduction mammaplasty and back-folded dermaglandular inferior pedicle. Breast J 13:226–232PubMedCrossRefGoogle Scholar
  5. 5.
    Ozerdem OR, Anlatici R, Maral T, Demiralay A (2002) Modified free nipple graft reduction mammaplasty to increase breast projection with superior and inferior dermoglandular flaps. Ann Plast Surg 49:506–510PubMedCrossRefGoogle Scholar
  6. 6.
    Casas LA, Byun MY, Depoli PA, Gradinger GP (2001) Maximizing breast projection after free-nipple-graft reduction mammaplasty. Plast Reconstr Surg 107:961–964PubMedCrossRefGoogle Scholar
  7. 7.
    Manstein ME, Manstein CH, Manstein G (1997) Obtaining projection in the amputation free nipple/areolar graft breast reduction without a vertical scar: using breast parenchyma to create a new mound. Ann Plast Surg 38:421–424; discussion 424–425PubMedCrossRefGoogle Scholar
  8. 8.
    Spear SL (2007) Breast reduction: inverted-T technique. In: Thorne C, Grabb WC, Smith JW (eds) Grabb and Smith’s plastic surgery. Wolters Kluwer Health/Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2008

Authors and Affiliations

  • Tonguç Isken
    • 1
    Email author
  • Cenk Sen
    • 1
  • Murat Onyedi
    • 1
  • Hakkı Izmirli
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryKocaeli University Faculty of MedicineKocaeliTurkey

Personalised recommendations