This 46 year old woman has not had children, and always felt her breasts were small and disproportionate despite staying in shape. She came to Minneapolis Plastic Surgery for breast enlargement with cohesive silicone gel implants, which she felt were much more soft and natural than saline implants. She knew they did not “leak,” and agreed with our belief that the latest generation of cohesive silicone gel implants (from all 3 manufacturers) do NOT require MRI scan every 2-3 years to look for “leakage.” She underwent submuscular silicone gel implant placement in an outpatient operation in MPS’s nationally-accredited (AAAASF) office surgical facility under a light TIVA general anesthetic. This anesthetic regimen is not usually used at hospitals because of higher costs, but TIVA results in significantly less post-operative nausea and vomiting (PONV) than the less-expensive and “routine” safe inhalation (gas) anesthesia used at hospitals or hospital-owned surgicenters. TIVA anesthesia is equally safe, but has less PONV (2-3%) compared to the hospital’s 7-28% PONV rates. Post-op photos are shown at 2 months post-op; additional softening and settling occurs over 6-12 months. Final photoset is 6 years post-op, showing natural results long-term.