There is continuing controversy regarding the most effective and safest technique for breast reduction surgery. This case series describes our experience with a breast reduction approach that combines three techniques aimed at addressing three different aspects of breast reduction: skin reduction, shaping, and nipple areolar complex shaping. We assessed the perioperative course and postoperative outcomes (for a mean of 19 months) of 10 consecutive women who underwent breast reduction surgery involving a combination of three techniques: “inverted T” skin reduction, modified Hall-Findley supero-medial pedicle for glandular reduction, and inferior de-epithelialized flap (modified “Foustanos” flap) for molding and improved shaping of the breast. The final bra cup size was C or D in all patients. The overall results were graded as excellent in four patients and very good in six patients. Each patient was completely satisfied with her surgery. Six patients developed venous congestion of the nipple areolar complex, which resolved within 24 - 48 hours after surgery. Two patients had uneventful delayed wound healing in the vertical scar of the inverted T pattern. There was a 100% nipple areolar complex survival rate. No patient had a major adverse event, permanently altered nipple areolar complex sensitivity, or bottoming out of the lower pole. None required revision surgery. This case series confirms our expectations that the solution to questions about breast reduction methods may depend on melding different techniques into a single procedure. The combination of techniques herein described was both effective and safe. Level of Evidence: Level IV, therapeutic study.