BackgroundInformation on optimal techniques and outcomes following secondary reduction mammaplasty remains sparse with only 280 patient cases reported in the literature to date. Methods7,179 medical charts of patients who underwent non-oncological breast reduction at the Cleveland Clinic Health System from January 2001 to October 2023 were screened to identify whether the procedure was a secondary reduction. Patient charts were then reviewed to extract demographic, surgical, and outcome data. Patients were also contacted through the electronic medical record to fill out the BREAST-Q V2 questionnaire about post-operative satisfaction. Surgical techniques and satisfaction were compared for patients with complications versus those without. ResultsOne hundred and twenty-two (1.7%) patients underwent secondary breast reduction. An inferior pedicle was the most used for both primary (n=59, 48.4%) and secondary (n=64, 52.5%) surgeries. The primary pedicle was re-created in 62 of the 84 (73.8%) re-reductions where a primary pedicle was known. A total of 15 patients (12.3%) completed the BREAST-Q questionnaire. BMI was significantly and negatively associated with satisfaction with outcome (R=-0.66, p=0.01), sexual wellbeing (R=-0.58, p=0.04), and physical wellbeing (R=-0.69, p=0.006). No patients experienced nipple-areolar-complex (NAC) necrosis following secondary reduction. However, 21 (17.2%) of patients experienced complications or breast fat necrosis following re-reduction. Unmatched secondary pedicles showed a trend towards higher complication rates than matched secondary pedicles (31.3% vs. 12.9%, p=0.051). ConclusionWhen known, the primary pedicle can be safely used for secondary reduction mammaplasty with minimal risk of NAC necrosis or complication.