This 56-year old woman has significant breast asymmetry, implant rippling, capsular contracture, and dissatisfaction with breast appearance. There is history of previous breast augmentation by another surgeon. She underwent removal of implants, capsulectomy, and revision breast augmentation and mastopexy with silicone gel breast implants placed under the muscle. The ptotic (drooping) right breast required a crescentic incision mastopexy while an inframmary skin excision was utilized on the left breast.