While many patients are looking for breast augmentation procedures, there are plenty who are interested in reducing the size of their breasts. Overly large breasts can be an issue for many women as it puts a lot of pressure on the spine, hence affecting their overall body posture. Moreover, big breasts can also be associated with dermatological conditions that occur at the level of the inframammary fold due to the lack of oxygenation in the area. Nowadays we have surgical methods to correct overly large breasts. Liposuction and breast reduction surgery can be performed to reduce the size of the breasts and enhance their shape. But how do we know which procedure is more suitable? First, let’s see what the anatomy of the breast is. The breasts are made of mammary gland tissue, fat, and a skin envelope. Liposuction only targets the fat tissue on the level of the breasts. So if the patient has thick fat tissue and a good skin quality, liposuction can be performed to reduce the size of the breasts. However, it is rarely that the shape can be improved with this procedure. Liposuction is contraindicated if the skin on the breasts presents stretch marks as this is a sign of poor elasticity. If we perform liposuction on breasts that are sagging or with poor skin quality, the sagginess will be accentuated, and the need for additional interventions might occur. The breast reduction procedure targets all the parts of the breast: mammary gland, fat, and skin. When this procedure is performed, the surgeon will excise a part of the mammary and also skin and fat tissue to achieve the desired size of the breasts. During this intervention, we have more flexibility in defining a better shape for the breasts as well. In my experience, I rarely find liposuction suitable to be performed with the purpose of breast reduction. However, I would recommend liposuction to be performed on the connecting areas after a breast reduction surgery. For example, if the patient has thick fat tissue on the sides of the chest and axilla, liposuction can be performed to improve the aesthetic result.