This is a 48 year old woman with a history of bilateral breast augmentation with 300cc saline implants and mastopexy, who wished to have improvement in the shape and size of her breasts.  She felt that the original implants were a bit too large and that they had bottomed-out, creating an overall boxy and bottom-heavy shape of her breasts.  She wished to have slightly smaller breasts with a fuller and more rounded shape.  She underwent bilateral removal of her old 300cc saline implants and secondary augmentation with 255cc silicone gel implants, which were supported within the breast pockets with Galaflex mesh.  She also underwent secondary breast lift (mastopexy) to create a better, more rounded shape of the boxy breasts.  She is shown before surgery and 9 months post-op.