* Revisionary breast surgery is sometimes subtle but can make a significant difference. That is the case with this 49 year old woman. She had had bilateral mastectomies and reconstruction elsewhere several years ago and was now having a problem with one of her breast implants. This was a good time to address an asymmetry and a few other details of her otherwise fairly nice reconstruction. As an out patient her left breast pocket was redefined and repaired and her implant exchanged, fat grafting was added the superior aspect of each breast, both implants were re-positioned and her reconstructed nipples were revised to give them more projection. The final outcome made a good breast reconstruction even better, proving that attention to detail can make a significant difference.