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

Background: The superolateral pedicle (SLP) is commonly used in our practice in breast reductions (BR) where the nipple-areolar complex (NAC) 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 2022 to January 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 SMP technique and 29 (17.7%) used the SLP technique. Median weight of breast tissue resected in SMP and SLP cohorts were 841.0 (range = 178-9,953) and 706.0 (range = 186-1,250) g, respectively (p=0.126). In the SLP group, 4 (13.8%) breasts experienced at least one 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 one 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 (3.0%) cases of reoperation, all in the SMP group. In a propensity score matching analysis, complication rates were comparable between SLP (n=30 breasts) and SMP (n=23 breasts) groups (average treatment effect on the treated (ATT)=0.067; p=0.713). Conclusion: 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 BRs.