Since the rule change permitting the inclusion of one dolphin kick during the underwater breaststroke pullout phase following a swim start or turn, there has been an emergence of several different pullout techniques adopted by elite swimmers. The aim of this study was to characterize the underwater breaststroke pullout technique trends and to assess the effectiveness of each technique as utilized by elite male and female swimmers. The sample included 60 swimmers (n = 26 male, n = 34 female) competing across the 50, 100, and 200 m long-course breaststroke final races from the World Championships 2015, 2017, 2019 and Olympic Games 2016. An above-water camera was used to identify and measure the different phases of the underwater pullout techniques, which was found to be a highly accurate methodological approach (ICC = 0.97). From the 150 trials analyzed, three different pullout techniques were identified: the Fly-Kick First technique, the Combined technique and the Pull-Down First technique. Although the most common underwater pullout technique utilized by elite competitive breaststroke swimmers was the Combined technique (n = 71), followed by the Fly-Kick First technique (n = 65) and the Pull-Down First technique (n = 14), it was observed that technical selection deviates according to gender. This indicates that male and female swimmers should not be coached adhering to the same technical model. This study found no significant difference in terms of performance outcome with respect to each of these techniques, indicating that technique selection should be guided by one's individual preference. It was concluded that the results of this study will serve as an up-to-date resource for coaches and swimmers working with elite breaststroke swimmers and as a useful insight to current underwater pullout trends.