The rearing of large litters from hyperprolific sows is a characteristic of modern genotypes. However, these sows have body and reproductive characteristics that differentiate them from the genotypes of the past decades, making it necessary to adopt different management strategies. This review describes the main care and challenges associated with the hyperprolificity of sows during the period in which replacement gilts are selected, along with gestation, parturition, lactation, and the weaning-estrus interval. It describes the challenges that these sows’ piglets will face during the lactation period and includes some strategies adopted to develop these surplus piglets. In addition, it identifies areas where more research is needed to understand the reproductive management of modern genotypes.