The above patient presents status post augmentation mammoplasty procedure with saline implants using the subpectoral approach by a different surgeon approximately 14 years ago. She presents with a ruptured right saline implant which is obvious on photograph No. 1. She also has bottoming out of the left breast. She will undergo bilateral removal and replacement of bilateral saline implants with high profile saline implants as well as open capsulotomy of the right breast and inframammary tightening of the internal capsule as well as inframammary skin excision along the left inframammary fold. This patient presents with a chronic leak which over the last six months has led to complete deflation of the right breast. Intraoperative photo shows a small amount of yellow fluid which is associated with an increase in protein to the right breast causing this dark yellow fluid. In the operating room the capsule was found to be completely encapsulated and the right upper pole of the pole of the pocket had collapsed and scarred down. She underwent a right open periprosthetic capsulectomy, circumferential open capsulotomy and left inframammary tightening procedure through an inframammary lift and internal inferior capsulorraphy and bilateral replacement with 465 to 500 cc high profile Natrelle implants through the inframammary approach. The postoperative view shows good symmetry, repositioning of the nipple areolar complex by tightening the left inframammary fold, regaining the right breast volume lost from the ruptured implant.