After Pitanguy’s seminal publication in 1961, many changes were made to the master’s original technique of reduction mammaplasty, which greatly expanded its fields of application. In our center, the application of the Pitanguy technique has seen a progressive increase in use in multiple surgical settings, in addition to its more classic use in ptotic breast remodeling. In detail, two specific areas of interest allowed in-depth analysis of surgical technique and its optimization: breast remodeling and breast reconstruction in the Massive-Weight-Loss patient population. This chapter will illustrate the reduction mammaplasty technique according to Pitanguy, with subsequent modifications proposed by the senior author, analyzing possible further applications in different operative settings.