At 60 years old, this patient was evaluated for breast reduction surgery with the complaint of very large dropping breasts. She had secondary symptoms of painful rashes underneath. Her goals were to be a very significantly small size, which she felt would meet her active life. Because of the very significant drop of the breast, a free nipple graft technique was utilized in order to gain the small breast size she desired. In conjunction with this, she also had brachioplasty (arm lifting) as an additional procedure. After surgery, her preoperative pain and rash vanished and she felt she could be much more active. She is quite pleased that her goals were met.