This patient, a woman in her mid-thirties, has had back, neck and should pain because of her extremely large breasts since she was a teenager. In addition to the large size, her breasts were unusual in that they had a baloon-like expansion of the skin and the nipples were displaced to the side, all shown in the pre-operative photos. She underwent breast reduction using a vertical technique removing over 3 pounds of breast tissue from each side. She is shown before and one year after surgery.