A breast reduction, also know as reduction mammaplasty is a procedure that removes excessive breast tissue. It has many different approaches in terms of the skin envelope work, and internal breast tissue rearrangement. It may be done for functional reasons, as when breast size interferes with daily living or exercise activity. Breast reduction is very commonly done for posture changes, chronic breast, neck, and shoulder pain. Finally, it may be done for purely cosmetic reasons. Wise pattern, Passot pattern, and Vertical reduction techniques are tailored to specific patient needs and preferences to include scar orientation, the degree of lift, and the degree of tissue removal. Generally, longer nipple areola elevation dictates the need to include a horizontal incision. The same can be said of larger tissue resection or excision, although many surgeons advocate the use of vertical incisions in both high weight breast removal and long NAC-translocation. This typically involves multiple little tweaks after the incisions have completely healed. Less frequently, breast parenchyma can be excised through a periareolar incision, leaving only a scar around the areola. This is typically combined with some degree of suction assisted lipectomy and is more in line with older and/or less dense breasts. The incisions can be quite lengthy but the recovery is very well tolerated. Using highly dilute local anesthetic, otherwise known as tumescent improves postoperative pain control, likely through pre-emptive anesthesia. Activities of daily living and self-care are usually resumed by the end of the first postoperative week. More strenuous activity, intense exercise, lifting anything over twenty pounds is not resumed until after four weeks from the time of the operation. As with most surgical procedures, complications are far more common in cases of morbid obesity, the presence of diabetes, vascular disease, and smoking. Breast reduction patients tend to be some of the most happiest and appreciative patients in plastic surgery. This is likely because their physical well being is just as improved by the procedure as their appearance.