It has long been recognized that overly large breasts can be a significant burden for women. Treatment was delayed until the advent of anesthesia. Initially, amputation techniques were used because they were relatively simple and straightforward. Surgeons began to understand that resection of parenchyma and skin should be designed to preserve nipple and areolar circulation. Numerous techniques were described over the years to reduce bulk, preserve the nipple and achieve an aesthetically desirable effect. Preservation of sensation and breast feeding potential were secondary. No perfect design was achieved, but plastic surgeons persisted in trying to improve the cosmetic results while maintaining some of the successes achieved in the past with combining resection with preservation of nipple viability. Surgeons attempted to reduce scars while achieving a good shape and today the controversy persists as to which procedure or technique is superior. As with many other decisions in plastic surgery, the answer comes down to surgeon experience and comfort along with individual patient indications and desires [1] . A thorough understanding of breast development and anatomy is a requirement for modern plastic surgeons. Advanced techniques of reduction mammoplasty, mastopexy, augmentation, and reconstruction demand comprehensive knowledge of the new detailed descriptions of breast architecture [2] .