The patient is a slender woman with minimal redundant chest skin and poor skeletal and inframammary fold support for a breast implant. She requests a high profile silicone gel implant for maximal size on her narrow diameter chest. A textured implant is chosen to minimize device movement and the inframammary fold is reinforced at surgery with deeply placed, long lasting absorbable sutures. Post operatively, she has appropriate stretch of the nipple to fold distance and maintains a well defined inframammary fold for an aesthetic result.