A very petite 62 year old had saline breast augmentation in Los Angeles almost 20 years prior. They placed over 400 cc implants, making her very large chested and imbalanced.  Overtime, the implants predictably stretched and dropped. She desired downsizing and a lift.  She underwent a superior pedicle mastopexy along with placement of a 200 cc mentor, moderate profile, saline implants. The after images were taken at six months.