In most cases breast reduction surgery does not require complete removal of the nipple areolar complex. Usually in the standard vertical and inferior pedicle techniques the nipple is left attached to an underlying pedicle of breast tissue and shifted to a more superior position without detaching it. In a small subset of extremely large reductions the pedicle lengths are too long to provide adequate blood supply to the nipple areolar complex and a free nipple graft technique is required. This procedure involves a complete removal of the nipple areolar complex and a reattachment to the reduced breast mound at the appropriate level. This allows maximal reduction in these patients while maintaining the integrity of the nipple and areolar skin. The main drawbacks of this technique is that the sensation of the nipple is lost, the nipple may lose its projection and become flatter, and in patients of color the areolar pigment can be affected.