The pattern of Wise (POW) is the standard technique adopted by Plastic Surgeons for breast reduction. To improve results with breast reduction, we adopted the SPAIR technique and found most results were excellent. However, some patients were not candidates for the SPAIR technique because of the extent of hypertrophy and breast ptosis. For these patients we developed a hybrid technique. Our hybrid technique has provided excellent results. The tailor tack method from the SPAIR is the key ingredient in obtaining aesthetically better results. Using the POW one commits to a pattern of skin excision before breast parenchyma is reduced -- this is why a boxy breast appearance frequently results. With our hybrid method, the breast parenchyma is first reduced before any commitment is made to skin excision. We have found that applying the advantages of the SPAIR technique to the more traditional POW technique, improvement upon our breast reduction results. The POW principle of inverted T-incision and vertical reduction is achieved that is not possible with the short scar techniques and by incorporating the tailor tack method of the SPAIR reduction technique, one can achieve breasts that have aesthetically excellent shape and projection while minimizing the extent of the scarring.