This is a 35 year old white female. She is 5’2” and 125lbs. She has not had any children. She works out frequently and is a non-smoker. She had subpectoral implants placed thirteen years previously through a periareolar incision. On the left side she had a periareolar lift. The textured saline implants had become firmer over the years and her desire was to be larger and at the same time revise the appearance of her areola. Her previous implants were 300cc that had been over filled to 330cc and her desire was to go up at least one cup size. In order to achieve her desired result using a periareolar approach she underwent a superior capsulotomy, replacement of her implants with 500cc moderate plus smooth silicone and a re-do periareolar mastopexy. Her postop healing was unremarkable and three months later she is well healed. The breasts have a more natural shape and at the same time achieved that larger size. The areola are now better positioned and sized. She is quite happy and is back doing all of her normal activities.