Background: In reduction mammoplasty, the new nipple position is often marked at 19 – 21 cm from the mid-clavicle. This may not be appropriate for all body sizes, and can leave nipples that are too high.

Methods: Fifty consecutive patients had preoperative measurements from mid-clavicle to the inframammary fold. The height, weight and BMI were recorded. At one-year post surgery, nipple distance from mid-clavicle and vertical incision length were recorded in 27 patients. The vertical incision length was compared to the 4 cm operative length, and the difference was called the change in the infra-areolar distance.

Results: The mean ideal nipple height as measured preoperatively by the distance from the mid-clavicle to the inframammary fold was 22.7 cm (18.5 – 27). This correlated with BMI (p <0.01), and did not correlate with height. The mean increase in the infra-areolar distance was 2.7 cm (1.0 – 3.5). This correlated with BMI (p <0.01), and with the amount of tissue resected (p <0.01).

Conclusions: The distance from mid-clavicle to the new nipple location is not a set number, but should be based on the BMI of the patient. Additionally, the infra-areolar distance lengthens and should be adjusted preoperatively to decrease the effects of “bottoming out.”