A method of breast reduction is presented that maintains the blood supply and innervation to the nipple and areola complex by means of an inferior pedicle, reduces the breast volume by removing tissue from the periphery of the breast, maintains breast shape with internal pliacation sutures, and limits the scar using a periareolar technique with a short inferior vertical to oblique extension. The short –scar periareolar inferior pedicle reduction (SPAIR) mammaplasty is a recently developed "limited scar" technique that attempts to combine favorable elements of several well established mammaplasty operations. Parenchymal resection and nipple transposition are achieved in a manner similar to the standard inferior pedicle reduction. Skin closure is achieved through a combination of periareolar and vertical techniques. Indication, operative technique, and pitfalls of the operation are discussed as compared to the conventional inverted-T inferior pedicle reduction mammaplasty.