Background: Modern techniques for breast-reduction surgery depend on large surface de-epithelialization. The current gold standard technique involves the use of a scalpel for sharp debridement and is a time-consuming process that is labor-intensive and often requires an assistant to stabilize the breast. Surgeons who perform breast-reduction surgery continue to search for instruments and innovations that may reduce the time and effort required for successful de-epithelialization. One such innovation is the use of the VersaJet Hydrosurgery system. The purpose of this article is to highlight an important complication that may result from the use of this device. Methods: The authors describe their experience with the VersaJet Hydrosurgery System in reduction mammoplasty of 28 breasts. Results: The authors experienced several complications characterized by the formation of epithelial inclusion cysts requiring reoperation. Conclusion: The VersaJet Hydrosurgery system may lead to quicker speeds of de-epithelialization as compared with traditional methods but poses a risk of epidermal cyst formation.