Successful breast surgery can signifi cantly impact a woman’s psychological well-being. Along with a positive body image, high quality breast surgery whether for reconstructive or cosmetic reasons can improve a woman’s self-confi dence and interpersonal relationships. Optimizing long-term outcomes is a goal for both the reconstructive and aesthetic surgeon. However, each situation presents with unique challenges. This chapter will address current thoughts on minimizing complications and avoiding unfavorable results in the reconstructive and aesthetic breast surgery patient to achieve optimal long-term results.