The apparel industry is a major contributor to environmental problems from textile manufacturing through garment production and distribution to consumer discard – donation, landfill, reuse, or otherwise (Gam, Cao, Farr, & Heine, 2009). In 2015, there were estimated 400 billion square meters of fabrics produced worldwide and 60 billion square meters wasted during apparel production. Vennström (2012) stated that in the United Kingdom around 2.35 million tons of waste comes from the clothing and textile industry per year, which estimates about 40 kilograms (kg) per person each year. Of the 40 kg (88 lbs.) of apparel waste each year, 74% ends up in landfills (Vennström, 2012). Even though the fashion industry applies a variety of technologies to minimize the fabric waste in pursuit of cost reductions, it is still far from eliminating the waste of fabric during the cutting process. On average, 15% of fabric is wasted during the cut-and-sew garment production process (Rissanen & McQuillan, 2016). Professionals and researchers in apparel design and product development discipline are facing a tremendous challenge of combining the innovative patternmaking methods, aesthetics of apparel design, and fabric waste reduction. Zero waste patternmaking offers a solution by utilizing the entire yardage of fabric, leaving no scrap left after the garment completion (Carrico & Kim, 2014). Further, zero waste has been touted as a means to more creative apparel design outcomes (Townsend & Mills, 2013). Many approaches to zero waste patternmaking have been proposed through a range of sources—blogs, websites, books, and articles (e.g. Townsend & Mills, 2013; Carrico and Kim, 2014; Fletcher, 2013; Antanavičiūtė & Dobilaitė, 2015). Unfortunately, many of these approaches are tied to the particular fabric width and finished garment size they are presented in. The aim of this chapter is to conduct a systematic review of these approaches. In so doing, we may understand the key principles and be able to apply them across a range of fabric widths and garment sizes. The main method will be to collect a representative sample of zero waste patternmaking approaches and analyze them. Approaches will be analyzed through visually for their pattern shapes, garment components, and three-dimensional finished garment shapes. Selected approaches will also be drafted, cut, and sewn to further understand the outcomes. Research questions include: (1) What are the major pattern design principles, (2) What outcomes do these results in? (3) What challenges exist with these approaches? These findings will provide information that will help designers successfully apply zero waste patternmaking methods in apparel design. Further, the research findings will provide focus for needed areas of future research.