Pleomorphic adenoma is the most common benign salivary gland neoplasm. The risk of malignant transformation to carcinoma is 1.5% in the first 5-years if left untreated. Accordingly, the current mainstay of treatment is surgical excision. However, this comes with significant risks. Some studies have shown up to a 26% risk of permanent facial nerve injury with parotidectomy. Although unilateral lesions are common, bilateral lesions are seldom reported. A 43-year-old female presented to her GP with a history of weight loss and throat pain. She was referred for a CT-neck which showed a soft tissue mass within the left parotid measuring 16mm. Biopsy of the lesion confirmed pleomorphic adenoma. 3-months later the patient was referred for an MRI head and neck which showed bilateral parotid lesions. Subsequent fine needle biopsy of the right lesion also confirmed pleomorphic adenoma. She was referred to a head and neck surgeon for consideration of bilateral parotidectomy to remove the lesions. Given the risk of facial nerve injury, the options considered were to either excise both lesions in a single procedure, or to adopt a staged approach and remove them on separate occasions. She was discussed at a multi-disciplinary team meeting at a tertiary centre. After discussions between surgical teams and the patient, the decision was made to perform a single surgery to address both lesions. Albeit a rare pathology, this case demonstrates the importance of patient-centred care in surgical decision making. These decisions should consider the risk and benefit of escalating surgical care, and include alternatives including disease surveillance.