A 40-year-old woman from Houston enlisted the help of one of the world’s most renowned plastic surgeons for the job of his career. Dr. Franklin Rose performed a breast reduction on Kerisha Mark, who had a 36NNN breast size.

You’re reading that right. 3 N’s. Here’s a look at the before and after pictures from the surgery.

Mark suffered from a rare medical condition called Gigantomastia that caused her breasts to continue growing far beyond anyone’s reasonable (or unreasonable) expectations. She said the large size caused her both physical and emotional pain, as people often came up to her on the street to talk about her unusual size.

Dr. Rose removed 15 pounds of breast tissue from Mark as part of the procedure. He said, “She is among the largest, if not the largest patients for breast reduction.”

Which N gave that away, Doc?

Joseph Misulonas is an intern for Playboy.com. He can be found on Twitter at @jmisulonas.