This is a 33 year old healthy white female. She is 5’7” and 135lbs. Her only previous surgery was an extended breast biopsy a year ago, which exacerbated her already asymmetric situation. The right side is now more ptotic than it was. Her bra size was a 34B with obvious asymmetry. The left breast is tight with a slightly deficient lower pole, whereas the right has a large nipple areola and is a bit more ptotic and larger, probably in the 50cc range. The best approach to her situation would be a differential dual-plane augmentation with release of the lower pole and a right periareolar mastopexy. After preforming external sizing she decided on a 400cc moderate plus smooth silicone implant for the right and a 450cc for the left. She underwent an uncomplicated procedure with a differential dual plane augmentation and a right periareolar mastopexy. Her postoperative course was completely unremarkable. Examination at two and a half months show that everything has healed nicely. She is now symmetric, her nipple areolas are at similar height, she has more lower pole fullness and she looks excellent. She is back to all normal activities and exercise. She is quite pleased with her new breasts.