This is a 45 year old healthy white female. She is 5’2” and 113lbs who over the years has lost approximately 40lbs. Her bra size was a 32C, but she had second to third degree ptosis with loss of superior fill. She was a non-smoker and had not had any children. The left breast was slightly more ptotic than the right and slightly larger. She desired a lift with slight increase in her overall breast size. In order to correct the ptosis she underwent bilateral subpectoral augmentation with a 200cc moderate plus smooth silicone implant followed by a vertical mastopexy with a slight reduction on the larger left side. Her postoperative course was unremarkable and photos obtained at four months show that she has obtained her desired result. The breasts are nicely elevated with proper position of the nipple and areola. The small implant has given her superior fullness without significantly increasing her overall breast size. She has achieved a significant lift utilizing only a vertical component. She is quite pleased and back to all normal activity.