This 43 year old female presented with 305 cc textured silicone Sientra implants placed many years ago. She desires a slightly larger and more natural look. She also has mild bottoming-out of the left implant and a wide gap between her breasts. She had implants replaced with 360 cc smooth round silicone implants. Adjustments were made to each implant pocket to optimize the implant position. She is delighted with her natural appearing post op result.