Appropriate tissue handling is an essential part of good surgical technique. Indeed, ‘gentle tissue handling’ is one of Halstead’s principles of surgery. Tissue handling involves respecting the tissues during surgery to ensure that they are not damaged. This can be achieved by the prevention of crushing, drying out, haemorrhage and damage to the vascular supply. An understanding and appropriate use of instruments and other techniques to aid tissue handling is essential. Good tissue handling is important as it will reduce or prevent complications such as surgical site infection (SSI), wound dehiscence, haemorrhage and seroma formation. The first step of improving tissue handling is to understand the basic principles. This can then be refined through practise and experience. It is vital that the surgeon reflects on their performance and strives for ongoing improvement. This can be enhanced by observation of peers, advice from an appropriate mentor and good planning prior to surgery. Refinement of tissue handling should improve surgical outcomes. Good surgical technique is characterised by accuracy and security rather than speed and apparent ease of performance.