We have here a 57 year old woman with a history of breast lift and breast implants placed in 2007 by another plastic surgeon. She came to see me because her breasts were too small for her frame and she wanted to go bigger, from a B cup into a D cup. She also wanted to have silicone breast implants placed and remove her saline breast implants which did not feel as natural. During the operation, I opened the cleavage area of the capsule and closed the capsule on the outside of the breasts. This caused her to develop better cleavage and prevented the breasts from falling off to the side, which was another aspect that bothered her after her first surgery. When removing her saline breast implants, I replaced these with fuller 450cc high profile silicone breast implants and she is now wearing D cup bra.