Comparison of Clinical Associations and Outcomes Between Superomedial and Inferior Pedicle Breast Reduction Surgery: A Retrospective Study

Introduction: Historically, the inferior pedicle (IFP) procedure has been the dominant technique for the treatment of macromastia; however, the superomedial pedicle (SMP) approach allows for decreased operative times, reduced incision tension, and improved and longer lasting superior pole fullness. The goal of this study is to investigate and compare the clinical outcomes and complications associated with the inferior pedicle and superomedial pedicle approaches to reduction mammoplasty. Materials and Methods: This retrospective study was conducted through a single surgeon’s experience with a total of 444 patients from 2005–2024. Patients were divided into two cohorts based on their breast reduction pedicle type. Chi-square tests and linear regression analysis were utilized to compare patient characteristics and surgical outcomes of the two pedicle types. Results: Of the total 444 reduction mammoplasty patients, 114 (25.7%) underwent the IFP technique and 330 (74.3%) underwent the SMP reduction. Patients in the IFP cohort had a significantly higher total complication rate of 57.0%, while the SMP cohort had a total complication rate of 46.1%. The prevalence of cellulitis was the only statistically significant difference between the two groups. 21.9% of IFP patients developed cellulitis post-operatively compared to 7.0% of SMP patients. Conclusion: This study supports the notion that superior pedicle reduction mammoplasty is as safe and may result in fewer complications than the current inferior pedicle standard. The overall complication rate, and specifically prevalence of cellulitis within the IFP technique may be attributed to four main factors: operative time, weight of breast resected, BMI, and drain status. Given the lack of similar findings in the literature, we believe our results may reflect differences in preoperative patient characteristics and postoperative management. Both techniques appear to have comparable complication rates and should remain essential skills for surgeons. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.