This is a 47 year old healthy white female. She is 5’4” and 130lbs. She has lost 65lbs over the last few years, 25 of which were over the last few months. Her bra size is a 34C, but without any volume. She had three children. The last one she breast fed. She is a non-smoker. Her desire was to be in the D cup range. Examination confirmed second degree ptosis with a loose skin envelope and loss of volume. In order to correct this she would require a vertical mastopexy with submuscular augmentation. Having compared similar cases she chose a 475cc moderate plus smooth silicone implant and underwent an uncomplicated augmentation mastopexy. Her postoperative course was unremarkable. Photos obtained at three months demonstrate that the breasts have healed nicely. They are elevated. The nipple areolas are in excellent position and she has obtained her desired fullness. She is back to all normal activities including working out and is quite pleased with her surgical outcome.