55 year old patient who had had a previous breast reduction elsewhere but felt her breast were still too big, she was wearing 38DD or 38DDD cup bras depending on the brand and wanted to be a 38C size. She underwent a revision breast reduction using a Wise skin pattern with an inferior central pedicle to maintain a robust blood supply to her nipple areolar complex and downsized her breasts to her desired 38C cup. She also underwent liposuction of her axillary fat pads, shoulders and posterior arms.