This 34 year old mother of 3 from rural Minnesota wanted larger and more equal-sized breasts. She consulted via e-mail and digital photographs, after which a deposit reserved her surgery date. On the day of previously-scheduled surgery, we reviewed her medical history and physical obtained at her regular doctor’s office, and she had her definitive consultation at Minneapolis Plastic Surgery, after which she and her surgeon agreed to proceed with outpatient surgery under TIVA general anesthesia. Different-size implants corrected her volume asymmetry, but she did not want periareolar scars to equalize nipple position (Right higher). She developed swelling in her right breast the night after surgery, and had another short (asleep) procedure the following morning to drain the blood and reduce the risk of capsular contracture. She did well, had no additional issues, and remained soft and symmetrical without capsular contracture at her one year recheck (after photos at one year).