Women have a variety of body shapes and sizes, thus no simple definition for macromastia exists (Shewmake, 1994). Multiple marking techniques have been suggested in the past. The majority aim to achieve some degree of precision in determining the angle between the two vertical limbs. This ultimately affects the amount of tissue resected and the postoperative shape. The free hand technique, being the most widely used, requires experience and practice to achieve the desired results. Multiple devices have been created to facilitate marking, including templates, keyhole patterns, goniometers, and others (Mendez and Fernandez, 1991; Lazarus, 1998; Palumbo et al., 1998; Paloma et al., 1998; Kavka, 1999). The study included forty female patients with breast hypertrophy. All underwent superior pedicle technique using inverted-T scar Reduction Mammoplasty, comparing the conventional breast marking technique and that marked pre-operatively in three positions: Sitting, Oblique and Supine (SOS). Patients were followed up for up to two years. The results showed that the three positions marking technique had better aesthetic outcome: Achieving both symmetrical markings and outcome and adapts easily with pre-existing breast asymmetry. However, the conventional breast marking technique still has its indications.