This is a 33 year old white female 5’ 1” 115 lbs and very fit. She had two augmentations 10 years ago. The first was subglandular with saline which resulted in significated rippling. She was then switched to a combination of silicone and saline implant which developed a bakers class 2 capsule on both sides resulting in the round typical melon like appearance with some drooping. In order to correct her situation she would require removal of her old implants and replacement in a sub muscular position. At the same time she would require vertical mastopexy to remove the excess skin and reposition the nipple areola in the appropriate position on the breast. Her desire was to be in the D cup range. She underwent the procedure with a 475 cc moderate plus smooth silicone prosthesis was used. Her postoperative course was unremarkable and after several months the implant have settled into an excellent position creating a natural breast mound with proper position of the nipple areola complex. She had no further problems with capsular contracture and photos taken a year later demonstrate well healed scars and a very natural and attractive breast.