Oversized breasts interfere with normal function and physical activity by causing back pain, postural problems, deformities of the back and shoulders, skin rashes under the breasts and breast pain. Though classified as a reconstructive procedure, breast reduction surgery has an important aesthetic component improving the shape of the breasts and enhancing one's overall appearance by making the breasts more proportional to the rest of the body.

The traditional technique for this procedure entails an incision that encircles the areola continues vertically down the breast and traces the inframammary fold. Once again, communication, planning and proper execution are critical to a successful outcome. Herein, final breast size should be anticipated prior to the procedure. Moreover, the resultant breast shape and lines of closure should prove to be aesthetically pleasing and not a disappointment. This breast shape must be conical, rounded and not boxy or square. Tension on lines of closure has been shown to frustrate, even thwart, the best efforts to minimize the prominence of incisions. Tension must be avoided when utilizing this technique thereby allowing for resultant lines of closure which are finely linear and relatively inconspicuous.

A different approach to this procedure is referred to as the vertical mammaplasty. This technique was modified by Madeline Lejour, M.D., a Belgian plastic surgeon, in 1989 and introduced to the United States at the national meeting of The American Society of Plastic Surgeons in 1991. The vertical mammaplasty, or Lejour technique as it is often referred, entails an incision around the areola with a vertical limb only. There is no incision beneath the breast mound. This distinguishing feature as well as the creation of a final breast shape which is consistently conical make this technique preferable to the traditional approach described above. Many plastic surgeons do not perform this procedure, however, as there is a relatively steep learning curve and a lack of familiarity with the nuances inherent in this technique could prove disastrous. In addition, this approach is limited with respect to the distance the nipple-areola complex may be elevated as well as the amount of breast tissue that can safely be removed at procedure which typically translates to one cup size.