This 77 year old woman in excellent health had undergone mastectomy and reconstruction many years ago with a Generation 1 silicone gel implant. She was displeased with her asymmetry. She underwent revision right breast reconstruction with capsulectomy and removal of her old implant, and placement of tissue expander, followed by a second stage removal of her expander, permanent silicone gel implant insertion, and simultaneous left breast mastopexy (lift).