Purpose: The advantages of the periareolar augmentation mastopexy technique are that it limits scars by mimicking the natural irregularity between the areola and the periareolar skin. The disadvantages are that it can cause: a flattened breast shape, stretching of the areolar complex, pouting of the nipple/areolar complex, and hypertrophic scarring of the incision caused by tension. Methods: We present a series of 10 patients (Age range: 21-41; Average follow-up: 1 year) treated between 2002 and 2004 who had various complications attributed to periareolar augmentation mastopexy requiring further surgery. Patient's subjective complaints and objective findings were recorded and followed. All patients refused to undergo the traditional anchor scar operation and were all treated by the vertical mammoplasty technique utilizing a medial pedicle. The implant pocket, size and shape were also altered as needed in order to obtain the best shape possible. Results: Using the vertical mammoplasty technique we achieved good nipple/areolar projection, removed the scars, decreased the areolar diameter, reset the nipple position, and corrected the ptosis. We present an algorithm to stratify these patients and provide our experience with this technique combined with the appropriate pocket and type of implant to address these challenging problems.