This is a 48 year old white female. She is 5’6” and a non-smoker, who ten years ago had subpectoral placement of 420cc high profile saline implants filled to 460cc with a periareolar lift. Over the years she has done reasonably well, but feels her breasts have become a bit larger and more ptotic. Her desire was to be smaller, tighter and lifted. In order to achieve her desired result she underwent a bilateral superior and medial capsulotomies, change of implants to 275cc classic smooth silicone with an inverted T mastopexy. Her postoperative course was completely uneventful. Photos obtained at three months show that the breasts have healed nicely. They are smaller, tighter and the nipple areola is in a nice position. The mastopexy scars are healing nicely and will continue to do so over time.