Risk Factors for Postoperative Complications After Superomedial Pedicle Reduction Mammaplasty

The superomedial pedicle (SMP) is a widely used reduction mammaplasty technique, but patient-specific risk factors may influence complications.

The aim of this study was to quantify postoperative complication rates and identify independent predictors after bilateral SMP breast reduction.

In this study, the authors retrospectively reviewed 643 consecutive patients undergoing bilateral SMP breast reduction for macromastia from January 2004 to December 2024. Complications were classified as minor (delayed healing, infection, seroma, hematoma, and necrotic events) or major (readmission and/or reoperation). Logistic regression identified predictors, adjusting for age, BMI or obesity class (BMI <30, Classes I-III), smoking, hypertension, and diabetes.

The mean age was 39.3 years (range, 14-74 years), and the mean BMI was 32.5 kg/m² (range, 18.9-58.2 kg/m²). The overall complication rate was 22.2% (15.4% minor, 6.8% major). The mean follow-up was 5.5 years. All obesity classes predicted minor complications and delayed healing. Only Classes II to III predicted any complication (all P ≤ .008) and infection (all P ≤ .025). In continuous BMI models, higher BMI (per 1 kg/m² increase) predicted any complication (P = .011), minor complications (P = .002), and delayed healing (P = .001). Smoking predicted major complications (P = .007) and reoperation (P = .033), whereas hypertension predicted any complication (P = .023) and readmission (P = .039). Total resection weight (per 100 g) was not a predictor of most complications, except nipple necrosis (P = .001).

The superomedial reduction technique is safe and reproducible even in high-risk patients. Postoperative complications are driven predominantly by patient physiologic risk factors rather than resection volume.

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