Background The superomedial pedicle with vertical scar (SMP) breast reduction (BR) is gaining popularity for its round, projecting breast and shorter incision when compared to the traditional Wise-pattern reduction using an inferior pedicle (IFP). However, there is a paucity of large volume institutional outcomes studies identifying how SMP/BR fares against more traditional methods of reduction. The purpose of this study is to compare outcomes after SMP/BR and IFP/BR in the only large volume, matched cohort study-to-date. Methods A retrospective review of a prospectively-maintained database of all bilateral BRs over the three-year period was performed. 100 SMP/BR breasts (50 patients) were matched to 100 IFP/BR breasts (50 patients). Matching was implemented based on age (+/− 3 years) and size of reduction (+/− 200 grams). Patient demographics including age, BMI, and ethnicity, size of reduction, NAC sensitivity, minor and major postoperative complications, and symptomatic relief were assessed. Statistical analysis was performed with SAS v9.2 (Cary, NC). Results 212 patients underwent 424 bilateral BR between 1/2009 – 6/2012 at a single institution; IFP/BR was used in 76% of cases. Mean age and BMI was 31.4 (+/−9.9) and 30.8 (+/− 3.5) in the SMP/BR cohort and 31.6 (+/− 9.9) and 31.8 (+/− 3.6) in the IFP/BR cohort. Mean volume of tissue reduced was 815 grams per breast (range 200–2068g) and 840 grams per breast (range 250–2014g), respectively. All patients achieved symptomatic relief. No statistical difference in major or minor complications was seen between two cohorts; SMP: major 4% (Return to OR 2%; wound infection 2%) and minor complications 25% versus IFP: major 3% (NAC necrosis 1%; hematoma 1%; would infection 1%) and minor complications 24%. No significant difference in complications was seen between small and large volume reductions. Conclusion SMP/BR is a novel, alternative mammaplasty technique with low complication rates and excellent functional and aesthetic outcomes. This is the first matched cohort study to demonstrate that SMP/BR can be used for a wide range of macromastia without a significant difference in complication rates when compared with the traditional Wise-pattern IFP reduction mammaplasty. Level of Evidence Prognostic/Risk, Level III

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