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This 36 year old woman from Sebastopol, California saw me with concerns of loss of breast volume and drooping of the breasts. She desired more volume and a breast lift. On exam she had some breast size asymmetry and we noted that she also had drooping of the breasts. We recommended breast augmentation and donut mastopexy, a procedure that adds volume through breast implants and removes some skin around the areola to tighten the skin envelope of the breast. After discussing both silicone and saline implants, the patient chose to proceed with a silicone gel breast augmentation with a donut mastopexy (donut lift). A 450 cc gel implant was placed on the left side and a 500 cc implant placed on the right side at the time of the procedure in our Santa Rosa plastic surgery suite. After surgery, the size of her breasts was close to even, her breasts are fuller and lifted, and she is wearing a large C cup bra.