This is a 65 year old female presented to the office with complaints of large breasts that causes her upper back and neck pain associated with deep shoulder grooving. Her breasts interfered with activities of daily living including her ability to exercise. Conservative management including special bras and weight loss did not improve her symptoms. Her pre-op exam demonstrated very large, ptotic, asymmetric breasts. She underwent a bilateral, superior pedicle, wise pattern asymmetric breast reduction. At 1 month, her symptoms have improved and her scars are beginning to mature.