48-year-old female presented to discuss options for breast enlargement. She was accompanied by her significant other; she has two grown children, who were both breast fed. She currently wears a 38C bra, and has never felt like her breasts were proportionate to her body. She states she has very broad shoulders, and she was hoping that augmentation will make her breasts more attractive and proportional to her body. She wants her breasts to look natural, and would be happy with adding one or two cup sizes. She does realize that “she has some mild sagging, and is hoping that she will not need a breast lift due to the scars”. Height is 5’7″. Weight is 165 pounds. Even though her primary goal was additional breast volume, because she had significant breast droop (ptosis), we explained that breast implants needed to wait until the ptosis was corrected with a breast lift. Once healed (typically 2-3 months later) if she still desired more breast volume, we could add implants without adding new scars (using the breast lift scars). She agreed to this staged approach, and proceeded with a mastopexy (breast lift). The procedure was performed in-office in our fully accredited (AAAASF) facility under light sedation and local anesthesia. After she had healed from the breast lift, she returned to our in-office facility for breast implant placement. Results are shown here 3 months AFTER the breast implants were placed in her second procedure (300 cc on the right, 250 cc on the left) under the muscle.