This is a 22 year old healthy young woman. She is 5’4” and 140lbs who presents with asymmetrical breasts. On the right side she had a bit of tuberosity with a short inframammary fold distance, which would require release with a dual-plane augmentation and periareolar mastopexy. On the left she had some glandular ptosis and would require a vertical component with a small reduction and differential size implants. After discussing all of the risks and benefits and the healing process she decided to proceed. She presented the day before surgery for sizing. A 425cc moderate plus smooth silicone implant was chosen for the right and a 400cc implant for the left with a small reduction and a vertical mastopexy. She underwent an uncomplicated procedure and she returned home the following day. Evaluation at two weeks shows her healing nicely, her symmetry is excellent, nipple areolas are in good position and the breasts themselves are already starting to develop a natural appearance. She will gradually increase activity and understands that over the coming months the breasts will soften and become even more natural.