An 18 yo with bilateral macromastia since the 5th grade who was wearing a 32 Double D bra . She needed to wear 2-3 bras just to support her breasts and had problems with back pain, shoulder pain, irritation of the shoulders from her bra straps, difficulty exercising and problems with her posture. She is petite at 5’1” and 112 lbs and had very large areola, which made it difficult to perform a traditional Inverted T scar technique. In her case we elected to perform a short scar technique, known as a Short Periariolar Inferior Pedicle (SPAIR) technique. This incorporates a permanent Gortex suture around the areola to decrease it’s diameter along with a “J” shaped incision. The blood supply to the nipple is from an inferior pedicle. She had the removal of 271 grams from her left breast and 336 grams from her right breast to reduce her to a 32 “C” cup, more in keeping with her frame. She is shown before and again, nearly 2 ½ years after surgery. Her symptoms have resolved. Her scars have faded. And she is thrilled with the new shape and size of her breasts.