The classification proposed by the author is practical, defining the breast not only as a bidimensional structure (the relative position of the nipple and lower pole of the breast to the inframammary fold level), but also as a tridimensional one, including the breast volume into the skin envelope. Breast ptosis represents a continuous challenge for plastic surgeons, difficult to be solved when people are more demanding and expecting the best results with minimal scars, less money, and short postoperative recovery time. The high rate of complications in this kind of procedures (breast augmentation and mastopexy) done at the same time demonstrates not only the technical difficulties in selecting the appropriate surgical procedure for each clinical case, but also the high risk of jeopardizing the vascular supply of the nipple–areola complex or skin flaps, especially in revision secondary cases. The techniques in various clinical cases are discussed.