Clinical outcomes and factors associated with lower-pole ptosis recurrence after superomedial pedicle breast reduction with glandular flap suspension: a retrospective study

To investigate the association of superomedial pedicle breast reduction combined with glandular flap suspension with lower pole ptosis improvement and postoperative complications, and to explore factors associated with lower pole ptosis recurrence. This single-center retrospective study included 78 patients who underwent superomedial pedicle technique breast reduction combined with glandular flap suspension from March 2018 to February 2025. At the distal base of the superomedial pedicle, a fascia-containing mammary tissue flap was created and suspended to the costal cartilage periosteum at the level of the third rib along the midclavicular line. The two glandular columns were sutured intermittently without tension. Among the 78 patients, 15 experienced recurrences of lower pole ptosis during the 1-year follow-up. At one year postoperatively, the bilateral Smith scores significantly decreased, with 84.6% of patients achieving a score of 0, indicating improvement in lower pole ptosis. Complication rates were 11.5% in the short term and 21.8% at the 1-year follow-up. Univariate logistic regression combined with LASSO regression identified BMI, upper bust circumference, left IMF distance, right IMF distance, and right resected tissue weight as candidate variables associated with lower pole ptosis recurrence. An exploratory nomogram was developed based on these variables for preliminary assessment of lower pole ptosis recurrence risk. Superomedial pedicle technique breast reduction combined with glandular flap suspension was associated with improved lower pole ptosis within the first postoperative year, but recurrence occurred in a subset of patients, and factors such as BMI and tissue excision volume may be associated with recurrence risk.