Comparative outcomes and safety of reduction mammoplasty performed by plastic and general surgeons: a 20-year retrospective cohort study of 1716 patients

Introduction Reduction mammoplasty (RM) is traditionally performed by plastic surgeons (PS), but an increasing number of procedures are now undertaken by general surgeons (GS). While all PS receive formal training in RM, training among GS is variable, and comparative outcomes between these specialties remain limited. The aim of this study was to evaluate and compare perioperative outcomes of RM performed by PS versus GS. Methods This retrospective, single-center cohort study included consecutive patients who underwent bilateral RM between 2005 and 2024. Patients were categorized according to the primary surgeon’s specialty (PS or GS). Demographic characteristics, perioperative parameters, postoperative complications, and the need for revision surgery were collected. Results A total of 1716 patients were included: 1335 in the PS group and 381 in the GS group. Mean age was similar between groups (44.3 vs. 44.8 years, p = 0.485). PS patients had slightly higher body mass index (BMI, 27.4 vs. 26.9 kg/m 2 , p = 0.015). Operative time was longer in the PS group (130.4 vs. 112.2 min, p = 0.001), while intraoperative blood loss was higher in the GS group (300.9 vs. 279.0 mL, p = 0.047). Overall postoperative complication rates were comparable (15.4% vs. 15.2%, p = 0.921), although wound dehiscence occurred more frequently in the PS cohort (7.5% vs. 2.1%, p < 0.001). Conclusions These findings suggest RM performed by GS yields complication rates comparable to PS within this single-center cohort. Differences in operative technique, patient selection, and perioperative management may explain outcome similarities, though residual confounding remains possible. Larger, prospective studies are needed to confirm broader generalizability.