Many reduction mammaplasty techniques have been described to obtain a natural cone shape with minimal scars. Several variations of the 'round block' periareolar mammaplasty (Benelli) were reported to minimize scars. Purpose of this study is to show a modified circumareolar reduction mammaplasty technique that is safe and effective in achieving natural breast shape and minimal scar with intact breast physiology. The emphasis is on that the inferior segment technique (Dowden) can maximize breast projection and to some extent, solve the intrinsic problems of the circumareolar technique, and also the breast parenchyma is manipulated (Ribeiro) to improve the breast shape. The position of a new nipple is determined using inframammary fold. The circumareolar incision and conventional inferior segment technique lines are marked. The width fo the pedicle measures 4-6 cm. Skin undermining is done except the inferior region. The resection of breast tissues are done medial to superior and laterally. Wedge resection of breast tissue in the superior pole is done and the gland is suspended onto the periosteum of second or third rib. Purse-string technique is employed to approximate the circumareolar incision using permanent sutures. Series of 76 consecutive cases (152 breasts) were reviewed from 1994-1997 with mean follow-up of 12 month (ranges from 8 month to 3 years), The weight of resected breast tissues ranged from 205 gm to 1200 gm with a mean of 427 gm. 72 out of 76 patients were pleased with the size and shape of the breast. There were few minor complications including one skin flap necrosis (1/152), one infection (1/152), 9 sensory changes of nipple-areolar complex(9/152). There were no major complications such as areolar complex necrosis, hypertrophic scar formation and wound dehiscence. Circumareolar reduction mammaplasty technique based on the inferior segment is a safe and effective surgical method. It provides an aesthetically acceptable scar with natural breast shape. This can be applied to the patient with small to large breast hypertrophy.