Background: The purpose of this study was to evaluate the safety and reliability of the superomedial pedicle with various skin reduction patterns and compare the surgical time with the inferior pedicle technique. Methods: A total of 279 superomedial breast reductions were reviewed from a six-year period. Assessments included skin pattern, average size of reduction, average body mass index, and complications. Risk factors and patient co-morbidities were recorded. There were no exclusion criteria. Results: There were no cases of loss in our series. The overall complication rate was 18%. The revision rate for contour or scar improvement was 4 %. A statistically significant reduction in operating time of 41 minutes (p= .0001) was seen when compared to the inferior pedicle reduction. Conclusions: The superomedial pedicle is a safe and reliable technique for reduction mammaplasty. The versatility inherent in the procedure allows for reproducible results in a broad range of patients with various skin excision patterns. Use of the superomedial pedicle provides consistent results with respect to breast contour, viability, lasting superomedial fullness, and saves operating time when compared to the inferior pedicle technique.