The final cosmetic result achieved by a mammaplasty is judged primarily upon the size, shape, and position the breasts assume with the individual in the erect position. For the past thirty-five years we have used the sitting position for certain mammaplasty procedures. It has proved especially advantageous and indeed mandatory for those mammaplasties in which the new nipple-areolar site has not been determined before operation. When we first used this position, complications were encountered. This finding prompted an analysis of the entire problem and the institution of measures to prevent complications. With time, a simple routine for positioning the patient evolved. Special measures are used to ensure the integrity of the cardiovascular, respiratory, and musculoskeletal systems. The peripheral nerves and peripheral soft tissue structures must be protected. If the proper care is taken, the sitting position for mammaplasty is safe, and it can be of real value to the surgeon.