The breast uplift-augmentation is a deceptively difficult procedure which effectively combines two independent and oftentimes, competing variables, one to enlarge a breast and the other to lift and thus tighten the overlying skin envelope. This may mitigate the final size the breast may achieve so that the lift does not compromise the closure or the resultant breast aesthetic. The virtual unknown that can occur during the course of this procedure requires both surgeon and patient to understand that there must be a degree of latitude given to the surgeon intraoperatively in order to accomplish both procedures simultaneously. This might translate to the use of a smaller implant than anticipated or a breast that is not as elevated as planned. On occasion, with complex revisions of prior work, capsule removal and/or pocket modification may eliminate the need to perform a lift altogether. This must be communicated with the patient prior to procedure and thoroughly discussed lest disappointment ensue.