A woman in her mid 50’s is shown before and again, 4 1/2 months after bilateral partial subpectoral breast augmentation combined with an inferior fold mastopexy. She is 5’3” and 112 lbs and had a nipple to fold distance when manually stretched to simulate the weight of an implant of 11 cm on her right and 10 cm on her left. As a general rule, if this distance is more than 9 cm it is better to remove some excess skin. The new breast fold was also anchored to the rib periosteum to strengthen the new fold and decrease the risk of the implants “bottoming out” and dropping inferiorly. She chose the ideal structured saline implant because she was concerned about silent rupture with silicone but wanted an implant that feels more natural than the traditional saline implants. After careful sizing based on her tissue dimensions she selected a 370 cc -415 cc Ideal structured saline implant filled to “100%” of 415 which gives a high profile.