Among the special cases encountered in cosmetic breast surgery, one of the most common challenges faced by plastic surgeons in private practice is breast lift surgery. This involves remodeling the breast’s shape, which is often affected—if not primarily defined—by the consequences of gravity (breast ptosis) and breastfeeding (resulting in flaccidity and asymmetry). The popularity of breast implants over the past two decades has significantly increased the number of patients with prostheses, which may be placed in either the subglandular or subpectoral plane. In both cases, breast aging follows a different pattern, requiring careful planning. It is essential to determine not only which surgical maneuvers to perform, but also which to avoid, in order to achieve optimal outcomes. The objective of this review is to highlight several maneuvers that we have incorporated into the technique I have adopted from my mentor, Prof. Ivo Pitanguy. These adaptations are based on the individual diagnosis of each patient and are applied to both primary cases (mastopexy with or without volume augmentation) and secondary cases (implant exchange with mastopexy, implant removal with mastopexy, and mastopexy with or without fat grafting—also known as the hybrid technique).