This is a 62 year old female presented to the office with complaints of large breasts that causes her back and shoulder pain, deep shoulder grooving, rashes, and difficulty finding bras that fit. She had tried other conservative measures to reduce her symptoms without benefit. Her pre-op exam demonstrated very large, sagging breasts with significant asymmetry. She underwent a bilateral, superior medial pedicle, wise pattern, asymmetric breast reduction. At 8 months, she is very happy with the size and shape of her breasts. In addition, she has none of the pain she originally complained of and no longer has no difficulty finding clothes that fit.