49-year-old mother of four with 20 year old saline breast implants. The patient noticed hardening of both breasts and now deflation of the right breast. She wanted to correct assymmetry, drooping and maintain a D-cup while elliminating contracture, rippleing and shelf like appearance. Following a detailed discussion of her options she elected to proceed with removing her old saline implants and replacing them with Natrelle Style 20 425cc silicone implants, left capsulectomy and bilateral mastopexy.