This is a 37 year old healthy female. She is 5’6” and 128lbs. Ten years ago she had a submuscular breast augmentation utilizing 300cc implants. Since that time she has had two children. At the time of her surgery she felt that she had glandular ptosis off of the implant and was larger than her initial desires. In order to achieve her desired result it was necessary to go with a smaller implant, a vertical mastopexy and a small inferior reduction on both sides. She decided to proceed. She underwent a change of implants to 215cc classic smooth silicone prosthesis, a vertical mastopexy and an approximate 40gram reduction inferiorly on both sides. Her postoperative course was uneventful. Photos at two months show that she is healing beautifully. The breasts are smaller, elevated and have a nice contour. She no longer has glandular ptosis and she has achieved her desired size.