Evaluating the Performance of Different Pedicles in Reduction Mammoplasty: A Comparative Analysis.

[METHODS] A retrospective chart review of 2500 patients having undergone bilateral reduction mammoplasty at 5 institutions from 2010 to 2019 was performed to record pedicle selection, patient demographics, comorbidities, body mass index, patient measurements to determine patient selection for different pedicle techniques, and clinical outcomes associated with these techniques.

[RESULTS] A total of 1186 patients had inferior pedicle technique, 65 had superior pedicle technique, 807 had superomedial pedicle technique, 148 had free nipple graft, and the remainder were not specified. A total of 1899 reduction mammaplasties were closed with wise-pattern skin closure, and 189 were circumvertical. Demographics were similar across groups except for higher age ( P < 0.001), BMI ( P < 0.001), and ASA score ( P < 0.001) in the free nipple graft cohort. Superomedial pedicle was used most frequently with lower sternal notch to nipple (SNN) distance, whereas inferior pedicle was performed most frequently with higher SNN distance. Inferior pedicle was most commonly employed for obesity class I-III patients, and free nipple graft was only used for obese patients. On linear regression, superior pedicle reduction (coefficient = -195.2, P = 0.001) was significantly associated with lower resection weights, whereas free nipple grafting was associated with a higher resection weight (coefficient = 752.8, P < 0.001). On univariate analysis, inferior pedicle technique was associated with higher dehiscence, delayed wound healing, and overall complication rates than other techniques ( P < 0.001). Regression analysis demonstrated only age and BMI as independent risk factors for overall complications.

[CONCLUSIONS] Inferior pedicle reduction remains the most popular pedicle design followed by superomedial pedicle, with wise-pattern closure the most common skin closure type. SNN distance was the most impactful physical exam metric used to choose pedicles. Inferior pedicle and free nipple graft were used most commonly for obese patients, whereas superior reduction was associated with lower resection weights and BMI. Inferior pedicle technique was associated with increased wound healing complications, yet regression analysis implicated only BMI and smoking as statistically significant in this regard. Superomedial technique performed well across different BMI classifications.