This woman came to me wanting to make her breasts somewhat smaller and symmetric. Using our Vectra photographic simulation system, we ascertained a difference in breast volume of about 180 grams. For the breast reduction, we used a vertical mastopexy technique, lifting the nipple areolar complex on a superior pedicle. It was necessary to "t off" the inferior portion of the skin from each breast to get the best esthetic outcome. We checked the progression of our reduction by seating the patient under anesthesia to double check our predictions. We removed 53 grams from the right breast and 233 grams from the left. She was pleased with the outcome.