Background: Pedicle de-epithelialization during breast reduction is traditionally performed using a surgical blade. The reliability of this method is hampered by the time-consuming nature, bleeding and safety concerns. In this study, a comparison of the use of the surgical blade to the diathermy was assessed for blood loss, surgical time and safety during breast reduction procedures at two breast units in Johannesburg, South Africa. >Methods: Fifteen patients undergoing breast reduction procedures with a total of 30 breasts (n=15 each for diathermy and surgical blade) were reviewed. Surgical swabs were weighed for blood loss differences and procedures were timed. Postoperatively, nipple sensation and nipple viability were determined in all patients. The data was analysed using STATA Version 16.0 suite of analytics software and a p value of <0.05 was considered significant. Results: The participant ages ranged from 18-59 years with a mean (standard deviation) of 34.0 (±12.8) years. The median and interquartile ranges (IQR) of blood loss from using the surgical blade was significantly higher compared to that of the diathermy at 25.4 mL (11.4-49.4) mL versus 10.0 mL (4.0-20.0) mL, respectively (p=0.003). There were no significant differences in the overall time taken in performing the procedures: surgical blade 13.0 (11.0-21.0) minutes vs diathermy 12.5 (9.0-14.0) minutes (p = 0.27). Apart from a hematoma in one breast in the surgical blade arm, nipple viability was 100% and nipple sensation was 93.3 % (14/15) for both groups. Conclusion: Despite similar safety profiles between de-epithelialization using diathermy versus surgical blade, the added advantage of significantly lower blood loss using diathermy suggests that the latter be considered over the standard surgical blade method during breast reduction and other procedures involving flaps.