This 37 year old woman has been a patient at Minneapolis Plastic Surgery for well over a decade, having undergone multiple laser treatments for a congenital birthmark. As a 37 year old mother of 2, she returned for breast augmentation after losing significant volume and developing mild breast droop. She underwent submuscular augmentation with the latest more highly-filled cohesive Allergan Inspira silicone gel implants, designed to reduce visible rippling in thin patients with little of their own breast tissue. Submuscular placement also helps to minimize rippling, as well as capsular contracture, as there is less bacterial biofilm on the surface of submuscular implants as compared to those placed below the breast, where ductal bacteria can contaminate the implant surface. Her outpatient operation was performed under TIVA anesthesia, and she had no PONV (Post-Operative Nausea and Vomiting). She had an excellent recovery and result, and her post-op photos show her appearance 5 months after surgery.