Is a reduction with free nipple graft the best option for me due to my breast size?

Without an exam it would be impossible to give you a definitive answer. However, from the measurements you listed it sounds like your surgeon has given you reasonable and safe advice.

I never do free nipple grafts breast reductions because the results are so poor. The nipple is numb and necrosis frequently occurs. There is a new alternative called The Ultimate Breast Reduction(TM). This technique reshapes your breast tissue creating upper pole fullness, elevates them higher on the chest wall and more medial to increase your cleavage. The size can be adjusted as desired and pain is relieved by transferring the weight of the breast to the underlying muscle. I have done this procedure on a woman as large as a 44 M. This technique does not leave the ugly vertical scars, maintains nipple sensation and the ability to breast feed.

Best Wishes,

Gary Horndeski, M.D.

Although distance from the sternal notch to nipple does help determine the ideal technique, it is hard to tell without photos or an exam, whether or not you "need" a free nipple graft. I use this technique but less and less now although very large reductions may be best suited with a FNG. Best to seek other opinions, even if it means traveling a bit out of your way. Other surgeons may concur or feel comfortable attempting preservation of the nipple.

It is very difficult to answer your question without photos or a physical examination. While the 44 cm from sternal notch to nipple precludes a superior pedicle reduction, you may still be a candidate for and inferior pedicle reduction if the distance from the inframammary crease to nipple is 18 cm.
Much depends on your desired size after the procedure as well as your height and weight.
Getting a second opinion is always a great idea if you have questions or concerns. Doing your research before surgery will give you comfort and peace of mind for your procedure. Good luck.

I have performed many breast reductions over the years and also do free nipple graft procedures when indicated. Even on very large breasts, it is rare that I do a free nipple graft. It is best to be seen in person.