PURPOSE: Ultrasound technology and liposuction have not been routinely applied to reduction mammaplasty. The use of third generation ultrasound technology(TGU) and liposuction as an addition to excisional surgery were evaluated. METHODS:TGU was evaluated in 113 consecutive patients undergoing reduction mammaplasty over a one year period. All procedures were performed by the same attending plastic surgeon and plastic surgery resident. Two patient groups were identified: 1) TGU application and excision; and 2) TGU application, aspiration and excision. The parameters recorded were: 1) operative time, 2) TGU time, 3) aspiration time/volume, 4) excision time/volume, and 5) complications. Patient follow up included evaluation on post operative day 3, 1 week, 2 weeks, 1 month, 3 months, and 6 months postoperatively. RESULTS: Operative time was reduced using TGU and aspiration. Excision and shaping were easier after TGU. The volume and quality of aspiration were enhanced by TGU. Time spent cauterizing and blood loss were reduced. The axillary roll was able to be aggressively treated. There were no complications directly related to TGU. CONCULSIONS: No increased rate of complications compared to those reported in traditional reduction mammaplasty procedures. TGU is a safe and useful adjunct for breast shaping procedures.