This woman had remarkably large heavy breasts. This breast reduction surgery was performed over 20 years ago. The reduction amount was aggressive at her request to be very small. However, the elevation of the nipple areolar complexes was too conservative. She would have benefited from more lifting. She was ecstatic with the changes to her breasts and actually declined a revision to lift the nipple and areolas higher. This is an example of when the lift component of the reduction does not meet the plastic surgeon’s expectation but did meet the patients desires. It is also shown to allow a person to understand that this is a possible outcome from the breast reduction.