This set of breast augmentation before and after photos features a 23-year-old white female (5’4“, 125 lbs) who presented with a bra size of 34B. She wished to be significantly larger (in the "full D" range), utilizing silicone prostheses and a periareolar incision. What made this case a challenge was the slightly lower position of the nipple areola, which with a large prosthesis, could be accentuated if not properly placed. We achieve her goals using 500cc moderate plus smooth silicone prosthesis and a duel plane augmentation. Post op photos taken one year later show that the inframammary fold has been noticeably lowered but the prosthesis have not completely settled. Her new bra size is a 34D and her periareolar incision has healed very nicely. At one year the breasts have settled completely, they look completely natural and enhance her frame with in a graceful manner.