This young woman had very heavy and large breasts and was interested in a breast reduction. She wanted much smaller breasts that were perky and she was not interested in breastfeeding in the future. We reviewed different options and together decided on a breast reduction with a free nipple graft technique. Post-op photos taken 1 year after her reduction show a dramatic result: 1.2 kg of breast tissue (over 2 ½ pounds) were removed from the left breast and 1.4 kg (over 3 pounds). Her breasts are now in balance with her frame, not drooping, and have excellent symmetry. The patient’s back and neck pain are gone, and she is thrilled with her results.