Tongue tie or ankyloglossia has been the subject of much controversy. As defined in this review, tongue tie occurs when a common minor embryologic tissue remnant—persistence of midline sublingual tissue that usually undergoes apoptosis during embryonic development—causes restriction of normal tongue movement. Effective breastfeeding requires newborns to fine-tune their tongue movements to adapt to their mothers' particular nipple and breast anatomy and physiology. In the presence of tongue tie, two categories of signs/symptoms arise: those related to nipple trauma and those related to ineffective breast emptying and low infant intake. Untreated tongue tie can lead to untimely weaning and its attendant health risks. Frenotomy is a safe and effective procedure to release tongue tie and improve tongue function and breastfeeding outcomes.