We aimed to identify risk factors that may influence surgeons’ decision on the use of surgical drains in breast reduction surgery. Medical notes of 182 patients were reviewed. The mean age of the patients was 38 years and the mean body mass index was 25.4 kg/m2. Eighty-three percent of the patients had bilateral breast reduction. The mean weight of the breast tissue excised was 581 g, with the inferior pedicle technique being the most commonly used (52.6%). Factors significantly associated with an increased total drain output were older age (>50 years, P = 0.001), and larger amount of breast tissue excised (>500 g, P = 0.004). Neither operative technique nor body mass index influenced the total drain output. We conclude that for patients of over 50 years old and breast reductions of more than 500 g, use of a drain should be considered. Younger patients and breast reductions of ≤500 g may not benefit from the use of drains.