This patient was an eighteen year old who presented to me for breast augmentation or revision. She had multiple difficult problems: Symmastia, capsular contracture, fold asymmetry, rippling. Following two previous breast augmentations in addition she had a developmental chest wall asymmetry. I reconstructed her chest wall pocket with Alloderm, performed open capsulectomy and exchanged her breast implants. Due to the difficulty involved in this reconstruction I was asked to present this case at the Allergen Breast Meeting at the American Society of Plastic Surgery Annual Scientific Symposium.