Notch to Nipple Measurement and Fold to Nipple Measurement
Plastic surgeons typically use the notch-to-nipple (N2N) and/or fold to nipple (F2N) measurements in determining whether or not you're a candidate for free nipple graft. Many plastic surgeons feel that at a N2N measurement of 40 cm and greater makes you a candidate for free nipple graft. A F2N measurement of 20 cm or more may indicate a need for a free nipple graft as well
Your notch-to-nipple measurement is done from the notch of your collar bone, which is to either side of that small indention at the base of your neck in the center, to the end of your nipple -- not the end of the areola. (See diagram below.) Measure from the right collarbone notch down and across to the right nipple, and then do the same for the left breast from the left collar bone notch. These measurements will be in centimeters. Additionally, your plastic surgeon should be performing these measurements for you at your consultation appointment.
The fold to nipple measurement is taken by placing the measure in the center of the fold under the breast and measuring to the end of the nipple.
Through the information and support at BreastHealthOnline, many women have found plastic surgeons who were able to perform a pedicle technique even with N2Ns of greater than 40 cm. A measurement greater than 40 cm does not automatically mean you must have free nipple graft. It is in your best interest to learn all you can about free nipple graft and make a commitment to yourself to try to find the most proficient breast reduction plastic surgeon you can. Sometimes this is not possible. Insurance company restraints may prevent you from using a physician outside your network. Logistics and finances may also prevent you from traveling to a larger city where a specialist is located. We understand this and we do not want women to feel bad if they cannot access these physicians. Our job is to educate you as to what your options are. What we do not want to have happen is for you to have an unnecessary free nipple graft and later discover there were options that you personally would have pursued.
Free nipple graft is a difficult topic because those who have had it can sometimes feel as though they did not do enough to prevent it -- particularly at a site where we stress learning all you can about it. Please understand that we must present all the options so that women can go into their surgeries prepared and informed. If for whatever reasons you are unable to utilize some of these options it does not mean you have failed. If you have read all the information, explored your options and considered your own situation then you have entered into your surgery with your own consent and understanding of free nipple graft.
What we do not want happening is women waking up with free nipple graft that they were unaware was going to be performed. There are doctors who have not kept up with the advances of their own profession who are performing free nipple graft routinely, not just when it is completely necessary. In cases of less than 40 cm notch to nipple measurements, it could have been prevented if the woman had the proper information and options available to her beforehand to make her own choices.