This is a 33 year old healthy white female. She is 5’7” and 150lbs, which is her stable weight. She had a subglandular saline augmentation 11 years prior in the 400cc range. She has done reasonably well, has had two children and breast fed, but now has ptosis related to the subglandular placement of the implant. Her bra size is a 34D, which she desired to maintain. She also developed some postpartum laxity both above and below the umbilicus which she also wished to correct. In order to achieve her desired results she underwent a change of implants to a submuscular position utilizing a 450cc moderate plus smooth silicone implant followed by a vertical mastopexy to remove redundant skin and ptotic breast tissue. She also underwent a full abdominoplasty with a mild plication and liposuction of the hip/waist area. Since she was out of town she stayed in the area for two days and had an unremarkable postoperative course. Photos obtained at three months show that she has healed nicely, the breasts have maintained their fullness even with the switch to the subpectoral position and now are high and properly situated on her chest. Her abdomen is flat, tight and she has regained her pre-pregnancy figure. She is back to all activities including exercise and is quite pleased with her surgical outcome.