This patient underwent implant exchange to smaller implants with an mastopexy. She previously had large implants placed on top of the muscle with bilateral capsular contractures and thinning of the breast tissues. I placed her new implants under the muscle and performed a breast lift. Due to the thinning on her right side from the pressure of the long standing capsular contracture, she required a free nipple graft on her right side. She has done well overall with the procedure.