Multitudes of procedures are used to correct hypertrophic breasts. In patients with mammary hypertrophy and excessive breast ptosis, the use of nipple-areola transposition techniques is a challenge. The thin superior lateral pedicle technique for reduction mammoplasty may solve these surgical problems. In this technique, mammary reduction is achieved using a thin superior lateral pedicle (1.5–2.0 cm gross). The resection is performed in two steps: (1) the base excess is resected at a plane perpendicular to the breast (which determines the cone’s height) and (2) the central half keel is removed (which determines the breast’s diameter). We used this technique for 80 patients in the past 10 years. The mean change in nipple position was 15 cm (range: 12–20 cm). The mean weight of each breast was 1500 g (range: 700–2000 g). Few complications were observed and patient satisfaction was high. Therefore, this is a safe technique for cases of severe mammary hypertrophy.