This is a 38 year old woman with a remote history of breast augmentation with saline implants.  She presented with progressive rippling distortion of the left breast and shape asymmetry.  The left breast had developed a grade IV capsular contracture.  She underwent bilateral breast revision in the form of bilateral capsulectomies and replacement of the old saline implants with 450cc round, smooth, moderate-plus projection silicone gel implants.  Her bra size changed from 36 C-cup to D-cup.