33 year old female with original breast augmentation over 10 years ago with a different surgeon, presents with capsular contracture on her left breast. Also feels implants are too big and fake and wants to downsize for a more natural appearance. Also desires improved softness of upper breast transition. A breast augmentation revision was performed with removal of her previous saline implant, removal of her entire capsule en-bloc, replacement with smaller 240cc silicone implants, and 150cc of fat grafting to each upper breast for a smoother transition. Results show a much more natural appearance and significant improvement in shape and symmetry.