Morphometric changes after superomedial pedicle wise pattern reduction mammoplasty - what we plan and where we end up

Superomedial pedicle-based reduction mammoplasty using a Wise-pattern skin resection is a well-established technique for breast reduction. However, long-term data on morphometric changes - such as nipple position shifts and lower pole expansion - remain limited. This study evaluated postoperative morphometric changes and their predictors at 3, 6, and 12 months after surgery, compared with intraoperative planning measurements. A retrospective cohort study based on prospectively collected routine clinical measurements was conducted in 100 female patients (≥17 years) who underwent primary bilateral reduction mammoplasty using a superomedial pedicle and Wise pattern. Pre- and postoperative data included demographics, comorbidities, resection weights, 3D volumetric assessments, and anthropometric measurements: midclavicle-to-nipple distance (MCN), lower areolar border-to-inframammary fold distance (IMFA), and areolar diameter (DA). Complications were graded according to the Clavien-Dindo classification. Generalized linear and logistic regression models were used to assess associations between patient- and surgery-related variables and postoperative outcomes. The median age was 39.5 years. Mean resection weights were 430 g (right) and 450 g (left), with 54% of cases ranging between 200 and 499 g. Median postoperative breast volumes were 630 cc at 3 months, 536 cc at 6 months, and 605 cc at 12 months. Minor complications (grade I) occurred in 15% of patients, and one grade IIIb event required reoperation. At 12 months, minimal nipple descent was observed (mean MCN increase of 1.01 cm), along with mild lower pole expansion (mean IMFA increase of 1.27 cm) and a slight increase in areolar diameter (0.25 cm). Higher postoperative breast volume was associated with greater morphometric changes, whereas larger resection weights (500-2000 g) and higher BMI predicted increased lower pole expansion. Postoperative morphometric changes were significantly associated with breast volume, resection weight, age, and BMI, underscoring the importance of individualized surgical planning and long-term follow-up to optimize aesthetic outcomes.