This is a 44-year-old with very asymmetric tuberous breasts. Her goal was to enlarge the size while improving the shape and correcting the asymmetry. Her goals were met by placing smooth surface round saline implants under the muscle and performing bilateral periareolar mastopexy to correct the tuberous breasts. The right implant is a 325 cc filled to 375 cc and the left implant is a 325 cc filled to 400 cc.