This is a 42 year old healthy white female who is a body builder. She is 5’9” and 158lbs, which is herstable weight. She works out frequently and underwent breast augmentation three years ago. The augmentation was in the subglandular position utilizing 450cc smooth silicone implants. Examination showed the classic melon appearance with the breasts sitting low on the chest. She also had a bakers class II capsule. Her desire was to create a more natural appearing breast, but at the same time maintaining her body building activities. In order to achieve her desired result she underwent an exchange of implants which were then placed in the subpectoral position utilizing a 490cc moderate profile smooth silicone, because of her wide base with. At the same time she underwent a vertical mastopexy for the redundant tissue. Her postoperative course was completely unremarkable. Photos obtained at two months show that she is healing nicely. The breasts are tight, more natural in appearance and now sitting in an appropriate position on her chest. The melon appearance has been removed and she now has natural appearing cleavage. She can now go braless and will gradually resume her activities as the gym.