This patient in her early 50s had her initial breast augmentation in the mid 1990s with an immediate procedure for implant enlargement after surgery. Three years later, she developed capsular contracture of the left breast and underwent removal of the implants and replacement. Four years later, she once again developed capsular contracture and had a similar revision procedure. She then developed the appearance seen in the pre-op photo with recurrence of her capsular contracture and significant distortion of the breast and loss of lower pole shape and fullness. She chose to undergo a revision procedure including bilateral implant removal (300 cc silicone), complete capsulectomy, inframammary fold repair and reinforcement, and placement of new round silicone implants (360 cc).