Dr. Gerardo do Rego Peixoto was a pioneering plastic surgeon who developed an innovative technique for breast reduction, aiming to minimize scarring while preserving vascular integrity and optimizing aesthetic outcomes. His method introduced four specific incision designs tailored to different breast types and degrees of ptosis, emphasizing skin retraction and glandular remodeling. Based on anatomical and physiological principles, the technique dissociates the breast tissue from the deep muscular layers while maintaining vital blood supply, allowing for safe and effective reshaping. This chapter details the techniques, principles, surgical steps, and modifications proposed by the author, highlighting its safety, versatility, and indications. Despite requiring a learning curve and patient compliance for optimal skin retraction, Peixoto’s method remains a valuable option for achieving natural, long-lasting breast reduction results.