The goal in breast reduction surgery is to reduce volume but at the same time to maintain circulation, sensation and breast feeding potential. A dermoglandular or central pedicle is the most likely to achieve all three. The superior pedicle is reserved mainly for very small reductions or mastopexies, but the author still finds the medial pedicle allows better lateral resection even in small reductions, and the lateral pedicle with recruitment of tissue allows for some "auto-augmentation" in mastopexies.