This 22 year-old nurse had one child and noted sagging, loose skin and decreased breast size after breast feeding. She requested breast enhancement with implants as an outpatient operation at Minneapolis Plastic Surgery. Her initial surgery was performed before November 2006; submuscular saline implants were used. After breast feeding a second baby she lost even more breast volume and developed implant rippling; a second surgery replaced her 420cc saline implants with 450cc silicone gel implants. Each of her outpatient breast operations took less than one hour, and utilized TIVA general anesthesia, which allowed rapid recovery without nausea or vomiting and discharge home in one hour. Implant rippling was eliminated, breast softness and position is improved, and cleavage space is decreased. Her final outcome is a much more natural result as well.