60 yo after bilateral mastectomy and reconstruction by another surgeon 6 years prior. She had significant implant malposition. As we age, some elasticity can be lost in the skin and a perfect result can be difficult. Here she is 3 months after bilateral revision of reconstruction with addition of Alloderm for support, exchange of implants to high profile smooth, round silicone and fat grafting. In these complex cases, a secondary revision is often necessary. That is what I have marked.