When teaching breast augmentation, although mastery of the technical aspects of the operation with emphasis on surgical precision is extremely important, achieving a successful outcome is more often the result of excellent preoperative and intraoperative decision making. Thoughtful consideration of the patient’s desired aesthetic result in conjunction with the anatomic characteristics of her breast and chest wall provides insight into the optimal implant and surgical approach. Selection of the appropriate implant, optimal incision, implant pocket, and inframammary fold location contribute to a satisfactory result. Technical aspects of the procedure also contribute to the final aesthetic result while minimizing undesired sequelae.