53 yo female who had bilateral subglandular silicone gel implants placed through periareolar incisions in 1996. She underwent exchange for textured round high profile 375 cc silicone gel implants in 2008. She was a 32A cup bra before the augmentation is now a 32D. She had grade 4 capsular contractures. She desired implant removal. She underwent breast implant removal, en bloc capsulectomies via IMF incisions and superior/medical pedicle mastopexies. Photos are 1 month post op.