Background and objective. Looking to improve on the aesthetic and functional results in breast reduction, we add to the central pedicle technique the use of a dermis mesh shaping and support forming a central cone to manage the mammary tissue. The periareolar skin agglomeration searches for a reduction in the size of the horizontal submammary scars. We describe this combination of techniques and analyze a series of patients. Methods. We conduct a retrospective analysis of a series of 300 patients operated in a period of 17 years. Results. It is possible to combine these techniques described in the literature. The central pedicle has a good vascular support and innervation, with low complication rates, obtaining a good result, with minimum nipple-areola complex and inferior pole ptosis. Conclusions. This combination of techniques is versatile for managing the volume and symmetry of the mammary gland and for nipple-areola complex mobilization. The dermis mesh produces a projected and stable central cone that when is covered by the skin, results in a more aesthetic, firmer mammary gland, with minimum ptosis on the long term and high patients´ satisfaction.