This case illustrates the critical importance of proper breast implant selection. A 27-year-old Dallas woman saw another plastic surgeon 18 months earlier. She had requested D-cup breasts; there was no other discussion of size or shape. In surgery, her surgeon placed Allergan 320cc low profile silicone gel implants. These are broad, flat implants. They did not fit her existing breasts well and didn't produce very pretty breasts. She wanted them changed but her plastic surgeon told her these were the largest implants her breasts would hold. When she consulted with me, the issues were her breasts were apparent: They were flat with little projection. The implants filled the tops of the breasts too much. The bottoms of the breasts were empty. The outer edges of the breasts looked tight. And the breasts weren't large enough to make her happy. We pinpointed her goals through dimensional analysis and photo review. This detailed consultation is a critical step in ensuring she and I went to the O.R. with the same goal in mind. During surgery, I released the pockets (breast implant capsulotomy) on the upper, outer, and lower borders. This created more space for the implants and rounded and softened the shape of the breasts. I replaced her implants with Allergan smooth, full-profile, silicone gel implants. This gave the patient the rounded, soft-looking large D-cup breasts she wanted. Her results pictured below are 6 months following her breast augmentation revision.