This patient is 24 years of age, whose favorite hobby is horse jumping. She felt that her breasts were markedly large, causing pain and problems with physical activities–especially with the horse. She also had shoulder strap grooveing pains as well as rashes. There was also significant imbalance, with her right breast being much larger than her left. Recommendation was made to achieve her goals with a central pedicle technique so the breast mound and nipple could be elevated and lifted as well. More tissue was removed from the right breast to achieve symmetry. Pictures are 6 months after surgery. She is very pleased with her new breast size, balance, and appearance, along with being comfortable horse jumping.