This lovely 55-year-old female presented as a 38-E bra cup size, and was having significant neck and back pain relating to her large breast size.  She found it difficult to exercise due to the pendulous nature of her breasts.  In addition, due to her asymmetries, she found it difficult to find a comfortable bra.

She underwent a vertical breast reduction with a superior-medial pedicle, with differential excision for the asymmetry.