Subcutaneous mastectomy consists of the removal of the mammary gland while preserving the skin and subcutaneous tissue for reconstruction. The significant amount of tissue in hypertrophic and ptotic breasts makes possible reconstruction by local dermofat flaps. The authors describe a technique for immediate reconstruction which is a combination of the Pitanguy marking technique for reduction mammaplasty and the Maliniac technique for reconstruction using dermofat flaps. The breasts are marked as for reduction mammaplasty; intervention begins with the deepithelialization of the marked area followed by incisions that leave an inferior dermofat flap. Glandular resection results in a cavity bounded by tissue. Reconstruction is carried out by the fixation of the inferior flap to the pectoral fascia, and molding is completed by uniting points at the midclavicular line. This surgical technique has been carried out successfully in 18 patients. Immediately following surgery all symptoms of fibrocystic disease disappeared; areolar sensitivity and erection returned four months after surgery, and aesthetic results were excellent. Breast contour was maintained, and dimensions were proportional. Patients have been followed between ten and twenty-two months postoperatively.