This 19 year old female was severely debilitated by her breasts. She wore a 38DDD bra and was more than 2 cup sizes larger on the right breast. The asymmetry of the breasts was her biggest concern. She underwent a “differential” breast reduction with lift to give her shape and balance and better symmetry of the breasts, as well as breast lift and size reduction. It is important to point out that breasts are never “identical twins” before or after any surgery; however, she is extremely happy with her improved symmetry, lift and size. These cases can be quite complex and something I am passionate about. I utilize a “volume preserving” technique on the left with superomedial pedicle so as to remove less tissue on the smaller breast and a more aggressive technique with superomedial pedicle on the larger right breast to further reduce the size and symmetry. She had 130 gram reduction on the left breast and 684 gram reduction on the right (which is almost 3 cup sizes difference). 4 year after results are shown with nice healing and almost imperceptible incision lines. Most of the time, several asymmetric breasts require multiple procedures to get the best symmetry. A further symmetry procedure could theoretically be attempted at this point on the right; however, the patient is extremely happy with her results from the single surgery.