BACKGROUND: Perioperative complications following reduction mammaplasty are well described in adults, yet there is a paucity of literature in the adolescent population, especially for the vertical reduction technique. METHODS: We performed a retrospective chart review of patients younger than 18 years undergoing bilateral breast reduction with vertical pattern skin resection and a superomedial pedicle at our tertiary care institution (2012-2023). Patients with less than 30 days of follow-up were excluded. RESULTS: A total of 48 patients with a mean age at surgery of 16.5 ± 1.7 years were included. Median time of last follow-up was 58.5 (interquartile range 37.2-232) days. Over the cumulative postoperative period, 12 (25%) patients experienced a complication. The most common complication was minor wound dehiscence (n = 9, 18.7%), followed by bleeding/hematoma (n = 3, 6.2%) and minor infection (n = 1, 2.1%). The complication rate was insignificantly greater in patients undergoing total excisions of 1000 g or more (29.2% versus 20.8%, CONCLUSIONS: The complication rate after vertical breast reduction in adolescents is comparable to what is reported in the literature for adults, with all complications being minor and not requiring reoperation. Our study supports the safety of this approach in adolescents, although larger resection (≥1000 g) and higher body mass index trend toward higher complication rates.