Free nipple grafting: an alternative for patients ineligible for nipple-sparing mastectomy?

Free nipple grafting is a useful alternative for patients who meet criteria for a nipple-sparing mastectomy from an oncology standpoint but are at increased risk for nipple-areolar complex necrosis or malposition due to large or ptotic breasts. Although there were initially questions regarding the oncologic safety of retaining the nipple in mastectomy due to early reports of transplanting carcinoma to the groin during banking process of nipple grafts, there have since been many studies that have demonstrated oncologic safety when adhering to particular criteria regarding the size, position, and type of tumor as well as nodal status. While free nipple grafting does have its own set of complications, patients tend to tolerate these with improved satisfaction as compared with nipple reconstruction using local tissue.