According to an American College of Chest Physicians consensus statement published in 2001, it is recommended that chest tubes should be used for the drainage of primary spontaneous pneumothoraces. However, more recent expert opinions and guidelines suggest that simple aspiration is increasingly recognized as an acceptable alternative treatment. Studies have shown that the success rates and recurrence rates of simple aspiration are comparable to, if not more favorable than, those of chest tube drainage and small-bore catheter aspiration. Simple aspiration is the least invasive modality and it has economic cost-saving benefits, particularly with respect to admission rates and hospital length of stay. Its complication rate is low. However, a larger size of pneumothorax seems to be associated with increased likelihood of failure of simple aspiration. The author reviews the available evidence relating to the use of simple aspiration as a modality for treating primary spontaneous pneumothorax.