Many different techniques of breast reduction have been introduced over the past 50 years. Many of the most recent techniques have attempted to improve long term outcomes of breast reduction with regard to consistency of shape, minimizing scars, and decreasing incidence of complications such as nipple sensitivity and wound dehiscence. Several of these techniques have based viability of the nipple-areolar complex on differ-ing vascular pedicles, each one claiming to have better outcomes than the other in matters such as shape, nip-ple-areolar complex viability, and nipple sensitivity. Many of the techniques can be difficult to learn while others may have shorter learning curves. Some techniques require longer operating times while others may require more secondary revisions. It is imperative for the surgeon, both experienced and inexperienced, to be familiar with several techniques so as to have an appropriate armamentarium from which to formulate an operative plan. Many patient factors must be considered, such as preoperative size of breasts, planned amount of reduction, previous breast procedures, desires of patient, and overall health of patient. All these points must be taken into consideration in the creation of an operative plan. © 2009 Springer-Verlag Berlin Heidelberg.