Rob, Free nipple grafting (taking nipples and areola off breast while
sculpting away the tissue for the reduction) is chosen by some surgeons for
cosmetic effect.  The nipples and areola are then able to be really centered
on the reconstructed breast.  Unfortunately, this results in greatly
diminished sensation to the nipple.  I consider this to be sexual mutilation
because it greatly changes sensation during sex  (making nipples either very
numb or painfully sensitive).  Also,  it effectively destroys lactation
capacity due to severing connection of ducts so that the milk no longer has
an outlet at the nipple pores.  The enervation of the nipple is also
connected with milk release via the mediation of oxytocin stimulated by
nipple contact. If that nerve is severed the milk fails to let down. So it
is a form of reconstruction that really affects a woman in some pretty
significant ways.  The central cone (also called inferior pedicle) type of
approach is much better in terms of preserving sensation and function.  It
preserves the nipple areolar complex on the breast and sculpts around a
central cone of intact tissue.  I have seen several women have pretty
successful lactations after that type surgery.  I've seen very bad lactation
outcome with the other approach.  It is wise to never say never.  I would
encourage the woman to try, but watch the baby closely.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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