 Hi everyone, Dr. Sawyer in Beverly Hills. We have our lovely patient here. She's late 20s, early 30s. She's starting to go up higher, but I'm trying to keep her age lower. She just recently had a baby, so congratulations. She had her breast fog done about 10 years ago, and that same time they did a breast lift. This is the circular breast lift they do. They call it the scarless breast lift. They call it the benelli breast lift, but what happens with this is that they try to cinch in the skin all around, but over time the areola just expands. You can see her normal areola should be about four seven meters, but look at how wide and long it is, especially on this side. The areola expands over time, so she had this done when she was 21, about nine years ago, and over time she's developed capsules. That's why her implants are up here and not down here, and over the same time the areola stretched. The areola again should be about this big, not this big, so what are we going to do for her today is we're going to take out the capsule. We are going to do a breast lift. We're going to do a vertical breast lift where we're going to bring the skin from the sides and move the areola up here, so if it's not elongated it's going to be the right size pulled up, take out the excess skin, probably keep the same size implant, but maybe go up maybe 10 to 20 ccs, so it's 10 to 20 ccs is not much, but we're going to keep her very athletic looking. So it's going to be a very nice case, stay tuned, she looks fabulous, believe it or not she has two kids, 11 year old, and a one year old, and she looks spectacular. We're going to make her fantabulous, stay tuned. So you guys can see how her areola has expanded. You can see the scar which I've outlined in blue, how it's just gotten, her areola went from this big to this big. Our normal areola is about 4, 42 millimeters, that's 4.2 centimeters, so we're talking about something this big. You can see over time it's expanded about a centimeter and a half all around, so what we're going to do is we're going to correct that today. So this is what the real areola should look like. You can see the outline I've cut it, that's the normal size of an areola. All the outside tissue is extra and it's just expansion of it because of the pressure put on the skin. So we're going to go through this and take out the implant and put another implant in first. So this is the suture that was put in there, this is a permanent, proline suture that was put in there to keep this areola small. You see how I pull it, it makes it smaller, but over time the skin expands. This is called a purse string suture and you can see when I pull it, it just pulls it in and the areola was initially that size, but over time again it expands. So we went through the skin, we went through some breast tissue, you can see the pectoralis major. So we know the muscle was underneath, the implant was underneath the muscle. So you can see when I hit it, it fasciculates. So we're going to go underneath the muscle to where the implant is. So we're taking out the old implant, we can see here's the implant, it's fully intact. It's a silicone implant. It is a Style 20 high profile, Allergan implant, 350cc. So it's fully intact, it's in good shape. So there's no leakage and we're going to take out the capsules. So you can see all this expanded areola tissue I'm going to take off and I'm going to bring in everything and cup around the original areola size. So we're going to take off all this extra skin that has expanded over the last 10 years. So we take out all the anterior capsule. Again, you could see the shiny surface, it was a smooth implant, it wasn't textured, but still anytime you have a foreign object in the body, the body forms a capsule around it. So now we could go inside the pocket, take a look. You could see it's nice clean. There is a posterior shell left, but you could see I kind of did a popcorn on it. Popcorn is when we bovee it and just pop it and make it decrease amount of shiny surface. I took off a little bit more of the posterior. Now we're going to put an implant in there, irrigate and cut off the excess skin and do a breast lift. So we use the Keller funnel with a no touch technique. We insert the end of the funnel, make sure that the implant goes underneath the muscle and bam, it's in. So when we took out the implant, I took out, I put in the new implant and I thought that I saw it go all the way to the side. So what I did is I put sutures all along inside. So close in the pocket. So when the implant goes, it stays on her chest. So she has internal sutures all along here to revise the pocket and make the pocket smaller.