This is a 56 year-old who had saline breast augmentation (200cc, subpectoral) with an anchor-type breast lift 17 years earlier who now felt her breasts were too large and wanted her implants out. She had a central chest depression from too much muscle release and some scarring from areolar loss from her initial procedure. She had removal of her implants, revision of her irregular periareolar scars, skin removal at her breast fold which also revised that portion of her anchor scar, and fat grafting to the breasts in the subcutaneous plane and around the pectoralis muscle (left 74cc, right 54cc to balance her asymmetry).
These are her 2 ½ month follow up photos. Note how the fat grafting also corrected her central depression and given her a very naturally beautiful breast shape.