In 1962, Professor Ivo Pitanguy published his novel technique for aesthetic breast surgery introducing essential concepts that would serve as the foundation for the development of newer procedures. Along the years, these principles were transmitted to thousands of trainees from around the world who visited his clinic. Increased knowledge of breast anatomy gave way to the development of several modifications performed to the original procedure, keeping its essence. The approach to the hypertrophic breast should not be taken lightly by the surgeon. In this chapter, we present the senior author’s personal surgical technique which shares features with the classical Pitanguy’s technique and incorporates changes in the pattern of skin resection. We believe it is simple and practical making it especially interesting for young plastic surgeons.