This over-augmented 36-DD cup patient felt matronly. She knew she needed a mastopexy but still wanted some superior fullness. I removed her over-filled old saline implants, tightened her breast pocket laterally (a capsulorraphy) to medialize the breast implant placement, and replaced her with moderate profile round 220cc silicone implants. A full mastopexy lifted her significantly, and her ribcage and trunk looked slimmer to go with her lighter, smaller breasts.