This patient is a 51 year old woman who had undergone previous breast augmentation, initially about 25 years ago, with a revision with lift about 6 years ago, who requests a procedure to remove her implants, have a smaller breast size, and reshape her existing breast tissue which has dropped following three children. Following discussion of treatment options, she elected to pursue a procedure to have her breast implants removed and have a revision breast lift approach that would attempt to provide optimal shape with the breast tissue present. She has been very pleased with her outcome to date.