This 60-year-old female did not like her nipple position and the saggy look of her breasts. She wanted more fullness but did not want a breast implant as she felt like she had adequate volume. After listening to goals, Dr. Steele and the patient agreed on a plan of a mastopexy with auto-augmentation, in which the lower breast tissue was not removed, but pushed up underneath the nipple/areola to give improved upper fullness without an implant. Her 3-month postoperative photographs show improved symmetry with a better breast shape and nipple position.