Aim: Common pitfalls with existing breast reduction techniques include poor aesthetic outcome, such as development of a boxy breast shape, and pseudoptosis. Presented here are a series of modifications to the technique of central mound breast reduction, based on previous work, aimed at ensuring consistent aesthetic results which are maintained in the long-term. Methods: All patients undergoing bilateral breast reduction by the senior author over a 7-year period were included, with outcome data collected prospectively. A detailed description of the technique is offered. Results: One hundred and sixteen patients underwent bilateral breast reduction over the study period. Mean follow-up was 20.6 months. There were no cases of nipple necrosis or infection requiring antibiotics. There was one post-operative haematoma which required surgical evacuation. Three patients developed a degree of fat necrosis which was managed conservatively in two, but required surgical debridement for liquefactive necrosis in one. Results of these breast reductions at the second post-operative year and beyond are presented. Conclusion: The technique described offers benefits of improved predictability, consistency and longevity of aesthetic results over existing techniques. Development of pseudoptosis in particular is effectively delayed. The modifications described have not been shown to increase the rates of surgical complications.