Background: Choosing an ideal technique for breast reduction is a challenging problem specially when the patient lacks an accurate expression of her desired breast size or shape as in the Egyptian society. This study focused on both objective and subjective evaluation of two commonly practiced techniques in breast reduction; the superomedial pedicle and the inferior pedicle.Methods: Nineteen females submitted for breast reduction in a comparative prospective study, 10 of them underwent a superomedial pedicle mammaplasty while 9 patients underwent an inferior pedicle mammaplasty. All the patients assessed for cosmetic outcomes and their satisfaction before and after the surgery.Results: There was no statistically significant difference between both pedicles regarding the rate of complications. The late post-operative breast measurements including the vertical meridian and nipple-to-inframammary fold distance showed significant higher values in the inferior pedicle group. Also, the rate of boxy-shaped and bottoming out deformity was significantly higher in the same group. Post-operative patient satisfaction showed some higher scores in the superomedial group. Conclusion:The superomedial pedicle has the advantages of better breast shape and contour and higher patient satisfaction.