The study included forty female patients with breast hypertrophy. All underwent superior pedicle technique, using vertical scar in twenty of them, and inverted-T scar in the other twenty. Patients were followed up for up to two years. The results showed that the vertical scar technique, when properly chosen and executed, had better aesthetic outcome; shape and scars, fewer complications and revision rates, more stable long term results, and higher patient satisfaction. However, inverted-T technique still has its indications.To choose either technique, triple assessment should be done:•Patient assessment; age, parity and maternity and patient selection.•Breast assessment; volume, width, and type of the parenchyma.•Skin assessment: skin excess, quality, and skin parenchyma relationship.