This 34-year-old had a breast augmentation 10 years earlier (subpectoral 430 cc silicone implants). She had gained weight over that time and felt that her breasts now were too large. She also had prominent ribs that prevented natural appearing cleavage (Photos 4A, 4B). She underwent implant removal, skin removal at the breast fold, and fat grafting in the subcutaneous plane and the subpectoral plane (left 44 cc, right 36cc). These are her 2-month follow up photos(Photos 4C, 4D). Note how fat grafting has created a natural transition to the breast from above and improved her cleavage centrally, bringing her breast folds closer together.