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* Here is a woman who had a breast augmentation two years prior elsewhere. She presented to our office because she was unhappy with the size of her breasts. She had wanted smaller implants when she had her original augmentation but her surgeon at the time put in 450 cc implants. She wanted to have her implants removed with no replacement. This resulted in a serious discussion. Once implants are put into the breast the remaining breast tissue becomes condensed around the periphery of the implants. This tissue does not always return to its native state when an implant is removed; the breast may not look like it did in its pre-augmented state. The discussion then proceeded to putting in significantly smaller implants. This required another discussion. Putting implants in a pocket that is larger than the implant results in a “rock in the sock” look that is not attractive. Her surgeon explained that a breast lift, removing excess skin would be needed in order to have an attractive looking breast. With those discussions behind them, decisions could be made. The plan was to do a bilateral implant exchange to much smaller implants and adding a SPAIR short scar breast lift. The implants that were placed were 175 cc with a moderate profile. The lift required an incision around the areola and a vertical incision to the inframmary fold. Her five month result shows a very pretty breast shape and much more appropriate size for her frame. An added bonus was a reduction of her areolas which had been stretched by her augmentation.