Breast reduction with or without pexy, with or without breast implants, is an extremely complex surgery, as numerous variants and parameters are changed at the same time. Even an experienced surgeon using techniques already enshrined in the literature may be misled. After 30 years of experience using various techniques of reduction mammaplasty, predominantly the classic Pitanguy technique, the author began to perform the Bi-Axial technique, with a higher success rate. In about 300 cases, improvements were observed mainly in terms of volume and shape of the breast, with a smaller horizontal scar of the “inverted T,” and compatible with the chest. When performing the classic Pitanguy technique, most of the time, there are difficulties in obtaining a satisfactory shape and scars. Thus, we decided to modify it reducing the axes separately—the Bi-Axial Technique. First the horizontal axis (laterolateral distance), by removing a vertical ellipse, which goes from point “A” to the inframammary fold. And so, the volume of the breast is measured. At the end of this phase, there will be a vertical scar, like the Arié-Pitanguy technique. However, frequently, this vertical scar is very long, which would favor the recurrence of breast ptosis. Then, we can implement the reduction of the second dimension, which is the vertical axis (cephalo-caudal). Breast reduction in two dimensions gives surgeon the chance to achieve the desired result step by step, unlike the most used techniques, in which the previous resection does not allow revisions or better adjustments later. The “pari-passu” character of this technique comfortably leads us to the desired breast shape. Thus, the success rate has been higher, achieving a good result most of the time. The Bi-Axial mammaplasty technique leads to a more precise tactic in the removal of the skin, gland and pexy with much less possibility of error.