64 year old female who underwent previous bilateral total mastectomy and implant based reconstruction elsewhere. She presented with severe contour deformity and asymmetry of the breasts. Revision was performed with several techniques. Pocket revision was performed with total capsulectomy and lateral and inferior capsulorraphy. This improved the contour and roundness of the breast giving it a more natural shape. The inframammary crease also became defined. A larger silicone implant was placed, and finally fat transfer was performed across the entire surface of the breast. She is shown 4 months after surgery and is very pleased with her improvement.