title: The Graf/Biggs flap to increase upper pole projection in breast reductions with free nipple grafts.
abstract: BACKGROUND
  Macromastia necessitating breast reduction with free nipple grafts often results in a breast shape that lacks upper pole projection. This study aimed to describe and review the experience with use of the Graf/Biggs flap to improve upper pole fullness in patients requiring breast reductions with free nipple grafts.
  
  
  METHODS
  A retrospective review evaluated patients treated by the senior author who had breast reductions with free nipple grafts and simultaneous use of the Graf/Biggs flap. Reduction amount, aesthetic result, and complications including hematoma, seroma, infection, fat necrosis, wound breakdown, and nipple hypopigmentation were studied.
  
  
  RESULTS
  A total of six patients, with an average follow-up period of 22 months, underwent breast reductions with free nipple grafts and simultaneous use of the Graf/Biggs flap. The average reduction amount was 2,583 g per side. There were no complications except for some early wound breakdowns at the lower T incision of the inframammary fold. These wounds resolved with local care. All the patients exhibited hypopigmentation of the grafted nipples and desirable breast shape, with excellent upper pole projection. All were universally happy with their result.
  
  
  CONCLUSIONS
  The Graf/Biggs flap is a reliable technique for increasing upper pole projection in the patient requiring breast reduction with free nipple grafts.
authors.affiliation: The Methodist Hospital, Weill Cornell Medical College, Studio City, CA 91604, USA. michaelalypka@hotmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Lypka
authors.forename: Mort
authors.initials: M
authors.lastname: Rizvi
authors.forename: Leo
authors.initials: L
authors.lastname: Lapuerta
mesh_terms: D000328:Adult; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009558:Nipples / Q000601:surgery*; D017060:Patient Satisfaction; D011184:Postoperative Period; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome