This is a 37 year old female who has lost 150 lbs and had previous breast augmentation. Her size was approximately DD cup and the implants were firm, malpositioned too high, with the nipples pointing downward. She wanted to be one cup size smaller, have a softer implants and have a more uplifted appearance of the breasts with the nipple position higher relative to the breast position. The previous saline 575 cc implant were removed, The capsule and pocket were sculpted and replaced with 450 cc smooth round silicone gel implants and a breast lift at the same surgery. She now has a D cup size that fits her frame and overall better shape and lift to the breast