Augmentation alone can successfully enlarge many women's breasts without the need to reduce the skin envelope or alter the position of the nipple. In women with excessive breast skin laxity, or in many cases of mild to moderate ptosis, a periareolar pursestring mastopexy is a useful adjunct to prosthetic breast augmentation. This allows tailoring of the skin envelope and repositioning of the nipple, leaving only a circumareolar scar.