Background <p>Reduction mammoplasty is one of the most popular procedures performed by plastic surgeons. Postoperative complications are often associated with obesity, a common risk factor observed in underprivileged areas where access to medical care is challenging. As such, we aimed to investigate the relationship between complications and socioeconomic status.</p> Methods <p>A retrospective review from a county hospital was undertaken. Patients were placed into groups according to local poverty cohorts. Complications evaluated consisted of wound dehiscence, surgical site infection, hematoma, seroma, nipple-areola complex necrosis, and venous thromboembolism. A systematic review was also conducted to assess outcomes from prior publications.</p> Results <p>The overall complication rate was 21.8%. Groups were notably different for vascular pedicle, skin incision pattern, and length of surgery; these characteristics therefore formed the basis of Model A using multiple logistic regression. Body mass index and tissue resection weight, previously recognized as confounders, comprised Model B. The combination of these constituted Model C. There was a non-significant trend of increasing complications for increasing poverty groups (aOR = 1.32/1.34/1.92 for Model A, 1.78/1.45/1.81 for Model B, 1.33/1.33/1.90 for Model C). Additionally, an abbreviated meta-analysis showed a weak correlation between complications and poverty (<i>r</i> = 0.49, <i>P</i> &gt; 0.05).</p> Conclusions <p>Our data do not support a direct association between complications and underserved areas. Compared to 12 prior studies, our patients had the fourth lowest complication profile despite the third highest poverty level. This may be attributed to an early prehabilitation process, outreach to social work, and flexible follow-up.</p> Level of evidence <p>Level III, risk / prognostic study.</p>