This is a patient who had breast augmentation 12 years earlier with submuscular saline implants, 325 cc, placed through a periareolar incision. Her lower breast tissue had thinned considerably so that the implant valve was easily felt through the skin and she had significant rippling. Her condition was corrected by changing to 339 cc smooth round silicone gel implants supported by an acellular dermal matrix (Strattice) and mastopexy.