A 22 year old who is very energetic consulted with me about breast saline implants. She never developed breasts and was wearing a AA cup. She wanted a natural result and was concerned about saline breast implants causing too much rippling after surgery. She requested a mid C cup and improved cleavage. Her examination demonstrated asymmetry with right nipple slightly lower than the left. Her left breast crease was also slightly higher. She is 5 feet 6 inches tall and 120 pounds. We used silicone breast implants in an off-label manner. During surgery, I did lower the left crease to a more appropriate level. I also placed 350 cc high profile silicone breast implants in each breast. I created a pocket as far as the pectoral muscle would allow me without disrupting the muscle attachments over the sternum. This combined with the high profile shape of her implants helped to achieve outstanding cleavage, symmetry and roundness. She now wears a solid C cup that truly complements her proportions and has increased her confidence. Photos are 3 months after surgery.