Superolateral Pedicle Breast Reduction for Patients with Medially Positioned Nipple-Areola Complexes

BACKGROUND: The superolateral pedicle (SLP) is commonly used in our practice in breast reductions (BR) where the nipple-areola complex is too medial, restricting pedicle movement and positioning. This study demonstrates the safety and efficacy of the SLP. METHODS: A retrospective review of BR patients from September of 2022 to January of 2024 was conducted. Demographic data, comorbidities, operative details, and complications were collected. RESULTS: A total of 164 breasts (84 patients) underwent BR: 135 (80.5%) used the superomedial pedicle (SMP) technique and 29 (17.7%) used the SLP technique. Median weight of breast tissue resected in SMP and SLP cohorts were 841.0 g (range, 178 to 9953 g) and 706.0 g (range, 186 to 1250 g), respectively (P = 0.126). In the SLP group, 4 (13.8%) breasts experienced at least 1 complication, including seroma requiring aspiration (n = 3 [10.3%]) and abscess formation requiring antibiotics (n = 2 [6.9%]). In the SMP group, 18 (13.3%) breasts experienced at least 1 complication, including hematoma (n = 7 [5.2%]), abscess formation (n = 4 [3.0%), seroma (n = 3 [2.2%]), dehiscence (n = 2 [1.5%]), partial nipple necrosis (n = 1 [0.7%]), and fat necrosis (n = 1 [0.7%]). There were 5 cases (3.0%) of reoperation, all in the SMP group. In a propensity score matching analysis, complication rates were comparable between the SLP (n = 30 breasts) and SMP (n = 23 breasts) groups (average treatment effects on the treated, 0.067; P = 0.713). CONCLUSIONS: The SLP technique for BR is safe and efficacious, showing complication rates comparable to the SMP technique, with no significant differences in resection weight. These findings support its viability as an alternative to traditional pedicle techniques in BR. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.