A retrospective review of patient medical records was used to evaluate a surgical procedure for reduction mammaplasty. Information obtained during this review was then used to determine areas of possible improvement in patient selection and in surgical technique. Modifications were made, and a second series of patients was treated according to the new selection criteria, and by a modified surgical technique. The medical records of the second series of patients were reviewed. The two series of patients are compared. The initial series includes a retrospective review of data collected on 43 consecutive patients treated for bilateral macromastia using the central pedicle breast reduction technique of Hester and colleagues. The results of this initial series of patients were reviewed and presented at the Northwest Society of Plastic Surgeons Meeting; Lanai, HI, in 1995. Data obtained from that review, resulted in modifications in patient selection criteria and in operative technique by the senior author (RPR). An additional 110 consecutive patients have been treated using this modified protocol. The authors review the same data for the second series of patients and compare the results of the two series. They illustrate the use of the central pedicle technique in 153 patients. They have used the central pedicle reduction mammaplasty technique of Hester and colleagues as a model to demonstrate evolution in a surgical technique after evaluation of data from the medical record. A 50% reduction in complications and a 35% reduction in operative time were obtained.