Closed-suction Drains Reduce Postoperative Complications After Inferior Pedicle Reduction Mammaplasty With Adjunct Liposuction.

[BACKGROUND] Adjunct liposuction is routinely performed during reduction mammaplasty (RM) to improve lateral chest contour. However, its impact on complications across pedicle techniques and whether drains modify this risk remains unclear.

[OBJECTIVES] To evaluate whether lateral liposuction is associated with postoperative complications in inferior pedicle (IP) or superomedial pedicle (SMP) RM, and whether drain placement modifies complication risk.

[METHODS] A single-institution retrospective cohort study was conducted of patients who underwent primary RM between 2019 and 2023. Patients were stratified by pedicle design (IP group vs SMP group), then by liposuction status within each pedicle group (IP(+L) vs. IP(-L); SMP(+L) vs. SMP(-L)), and finally by drain placement among liposuction patients (IP(+L)(+D) vs. IP(+L)(-D); SMP(+L)(+D) vs. SMP(+L)(-D)). Outcomes of interest were 90-day postoperative complications. Stepwise multivariable logistic regression models evaluated associations, and significance was set at p<0.05.

[RESULTS] Of 394 IP patients, 20.8% (82/394) were IP(+L), and 72.0% (59/82) of IP(+L) were IP(+L)(+D). Of 648 SMP patients, 17.1% (111/648) were SMP(+L), and 36.9% (41/111) of SMP(+L) were SMP(+L)(+D).IP(+L) was associated with increased odds of any complication (OR 2.67, 95% CI 1.50-4.77; p=0.001) and T-point breakdown (OR 3.90, 95% CI 1.28-12.10; p=0.017). Among IP(+L) patients, drain placement was protective against T-point breakdown (OR 0.05; p=0.014) and seroma (OR 0.14, 95% CI 0.01-0.93; p=0.042). No seromas occurred in the SMP(+L) cohort regardless of drain status.

[CONCLUSIONS] Adjunct liposuction increases complications in patients who underwent IP RM but not those who underwent SMP RM. Closed-suction drains mitigate T-point breakdown and seroma specifically in IP(+L) patients, supporting routine drain placement when liposuction is performed with IP.