Purpose: To thorough light on suction assisted lipectomy versus direct defatting of inferior pole of breast in superiomedial pedicle reduction mammoplasty. Background: Reduction mammoplasty is widely accepted as an effective means of relieving many of symptoms like breast pain & psychological symptoms related to unwanted attention. Patients and methods: This study included 34 patients having huge breast. Who were managed superiomedial pedicle reduction mammoplasty. In group I (n =17), the lower pole shaping was achieved with direct defatting, group II (n =17) the inferior pole and inferolateral aspect of the breast was approached with liposuction. After evaluation by complete history, examination and investigations. Results: There is significant decrease in post-operative nipple height and areola diameter and nipple to sternal notch measurement and elevation of inframammary fold in both groups; P value