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Objectives: Complication rates in breast reduction surgery can go as high as 40 percent. Vast surgical experience along with sound surgical principles and technology helped in reducing the complication rates and maintaining stable long term results. Introduction: Amongst all aesthetic surgical procedures, reduction mammaplasty or breast reduction has the steepest learning curve in terms of understanding and mastering the procedure .the fact that our literature shows a myriad of procedures of breast reduction is a testimony to the fact that no single procedure till date is the best for performing a breast reduction in a given breast. The plastic surgeon not just removes the excess breast tissue to restructure and reshape the breast ,but must understand the dynamics of restoring the structure of the breast by understanding the blood supply to the nipple Materials / method: A total of 142 female patients requiring breast reduction in excess of 1000gms per side were included in the study. Patients undergoing minor breast reduction weren't considered for the study. Hall Findlay technique and its modifications was performed in all the 142 patients. Results: Catastrophic vascular complications in the form of nipple areola necrosis was averted in all patients despite a very long SN- N distance in excess of 40 cms. In such cases, a preliminary delay procedure was performed followed by the definitive procedure a week later. The early experience of the authors showed a high incidence of wound healing problems like wound dehiscence, delayed wound healing and seromas. These complications were reduced significantly in the author experience by the use of incisional negative pressure wound therapy. Conclusion: Bottoming out - which is one of the late post operative problems in breast reduction was averted by the use of derma fascial flap, thereby maintaining a stable areola-IMF distance in the long term, preventing the star gaze or a pseudo ptotic appearance of the breast. Complication rates in breast reduction surgery can go as high as 40 percent. Vast surgical experience along with sound surgical principles and technology helped in reducing the complication rates and maintaining stable long term results.