*If there is anything that will limit the size of an implant that can be used in breast augmentation it is a tight skin envelope. Such was the case for this 40 year old mother. Despite her three pregnancies, her breast skin and soft tissue remained tight. Her surgeon had a lengthy discussion about the physical limitations (she) presented and her goals for breast augmentation. There are some tricks available to encourage the skin to stretch and all of them were all used in for her. One of them was to add fat (80 cc was used in each breast) to her skin envelop in addition to the 225 cc anatomically shaped breast implants. She is one year out from her procedure with a very pretty breast shape. Her breasts are a little smaller than she desired, however, they are much more proportionate to her body habitus than before her procedure.