The patient is a woman who had breast augmentation approximately 20 years ago. She had early upward displacement of the implant. She recently had a right side deflation and presented for repair. She had the left side deflated in the office under local anesthesia to allow the breast tissue to recoil and be more symmetric to the right side. I have used this approach for a few years, and was happy to see an article on it published in one of our Plastic Surgery Journals recently. Optimal deflation time was found to be about one month before surgery, but I have seen benefit from two weeks before. Note the left upper chest depression – this is due to long term compression of soft tissue leading to volume loss. The patient then had bilateral capsulectomy and implant exchange for silicone to minimize rippling.