This 58 year old came to me unhappy about her 41 year old breast augmentation, gel implants, subglandular.  They had grade four capsular contracture and a very bizarre shape.  We removed the implants and performed a total capsulectomy.  A biplanar pocket was created and, using sizers, we found volume asymmetry.  This was corrected with Allergan gel implants; 20-300 cc on the right; 20-350 on the left.