Periareolar mastopexy without the use of implants has a few indications that have recently increased by the use of fat grafting. Oppositely, Compound Periareolar Mastopexy (CMP), i.e., associated with implant placement, can be very useful in a large number of patients. The technique may appear easy; still, several principles must be followed to achieve satisfactory results. Choosing the amount of skin to be removed and the type and size of the appropriate implant is essential; however, many other surgical details described in the paper are important to achieve good results. The fulcrum of the operation is the periareolar suture. We have used for the last 25 years the “DIC” suture. It consists of two 3/0 nylon sutures catching intradermal bites carried out after a superficial periareolar deepithelization, entering and exiting at 3 and 9 o’clock along the areolar circumference. The sutures are placed concentrically and tightened to the chosen areolar size. This technique dramatically decreased the complications related to the periareolar scar, which are frequent after this surgery. Postoperative flaws may also be associated with the choice of implant. We often use polyurethane implants for their predictability regarding minimal capsular contracture and absence of dislocation. Other complications regard the areola, which can enlarge due to a “dermal fracture” in patients with thin dermis, and the periareolar scar that may become visible due to inappropriate suture technique. Lower pole irregularities are frequently reported after CMP due to the necessity of IMF lowering in many patients submitted to this surgery. Choosing the right implant, avoiding excessive volumes, and limiting IMF lowering are essential measures. The recently published Rotating Abdominal Flap (RAF) represents an excellent solution to prevent and treat double-contour deformity related to CMP.