This 37 year old woman came to Minneapolis Plastic Surgery requesting more breast fullness as well as a more youthful, lifted position. She understood that shaping of the breast skin envelope in both horizontal and vertical dimensions would give the best shape, the most long-lasting lift, but require incisions and scars around her areolas (though not detaching them and therefore preserving sensation in about 85% of cases), her inframammary creases, and vertically from the creases to her areolas. Since we use only below-the-skin dissolving sutures, she knew she would have no crosshatch or “railroad track” suture marks, just thin scars that ultimately fade over 6-12 months in most patients. She also added cohesive silicone implants, increasing her breast volume by about a bra cup size. Her outpatient surgery took just under 4 hours, and her TIVA anesthesia allowed a rapid, nausea-free recovery.