Evolution of breast reduction techniques has been a result of combining different skin marking patterns with a wide variety of pedicles. Despite the many differences that may exist among these procedures, they all rely on a few key principles. To make surgery more expeditious and minimize technical challenges, these principles can be incorporated into simple surgical strategies. The authors present a step-by-step approach to help to achieve a successful cosmetic breast reduction for patients with small to moderate breast hypertrophy. Special emphasis is given to intraoperative clues that make this procedure more reproducible and straightforward.