This is a 64 year old mother of three children who had breast augmentation over 35 years ago. She presented with a “waterfall” deformity of her breasts with breast tissues sagging down from her large breast implants. She wished to have the old implants removed and the breast tissues lifted. She underwent breast implant removal and total capsulectomies followed immediately by mastopexies (breast lifts). She is shown before surgery and 4 weeks post-op.