Reduction mammaplasty and mastopexy is one of the biggest operation groups which have many techniques and their modifications. Generally accepted that, new modifications are the results of improvements of existing techniques. In this study we present a new modification of Moufarrege total posterior pedicle mammaplasty. We performed central plication to achieve a juvenile look in the superior pole of the breast and to prevent postoperative pseudoptosis and used central U shaped flap to achieve maximum NAC safety and to preserve lactation and nipple sensation. Sixty-nine patients were operated with the above mentioned tech-nique. Out of 69 patients, 52 underwent reduction mammaplasty (11 had gigantomastia), eleven mastopexy, and six oncoplastic. All of the patients were satisfied with functional and aesthetic results and none of them had major complications such as total NAC loss. Only six patients had wound healing problems on the suture line and two patients had minimal hematoma. Since we performed conical plication we would like to evalu-ate long term effects of the plication in the breast parenchyma. Breast parenchyma was visualized with USG in younger patients and mammography in older patient in postoperative 6 months and 1 year. We never observed any problem related with our sutures and retroareolar part of the areola examination for ductal patency was performed and interestingly all the patients had very clear ductal patency. Our modification is a safe, reliable technique which creates the least scar, avoids previously described disadvantages, provides maximum preservation of functions, can be employed in all breasts regardless of their sizes and is appropriate for oncoplastic surgery and revision surgery