This is a 42 year old healthy white female. She is a 5’4” and 155lbs, which is fairly stable for her. She did have six children through natural birth and breast fed them all. She has had a laparoscopic cholecystectomy in the past and is a non-smoker. Her bra size was a 36B, but she had a short nipple to inframammory fold distance and a constricted base. Her desire was to be in that full C bra size range. She had a base width of 13.5cm. I explained to her that her breasts would have to be approached as in a tuberous breast deformity with a periareolar incision, releasing the lower pole, dual-plane augmentation and periareolar mastopexy. She understood that this would elevate the nipple areola, but was limited by the deficiency of skin. As far as her abdomen was concerned she would require a full abdominoplasty with a mild plication for the postpartum laxity and mild separation of the rectus muscle. Having discussed all of the risks and benefits she decided to proceed and underwent the augmentation mastopexy utilizing a 425cc moderate plus smooth silicone implant on the right and a 400cc implant on the left since the left breast was slightly larger. She also underwent a standard abdominoplasty with plication and liposuction of the hips. Her postoperative course was completely uneventful. She was back to her duties as a nurse at three weeks. Photos obtained at three months show that she is healing quite nicely. The breasts are now at her desired fullness with nice elevation of the nipple and areola despite the limited inferior tissue and constricted base. The areola no longer point downward. The abdomen is flat, tight and shows no further residual from her six pregnancies. She is back to all normal activities and is quite pleased with her surgical outcome.