This patient presented with bilateral tuberous breasts, ptosis (sag) and constricted breast anomaly. This is one of the most challenging (if not the most challenging combination of findings that plastic surgeons must face regarding aesthetic breast surgery). The plan here included reduction (elimination) of sagging elements, elevation and resizing the nipple and areola, and implant augmentation to yield a final C cup outcome. (Lift alone would have only given a small B cup breast.) An outstanding result.