Body contouring procedures after massive weight loss are becoming more and more common in this era of widespread obesity and increasing rates of gastric bypass procedures. Although the recent literature has presented numerous discussions about the treatment of redundant abdominal tissue, little has been published about breast contouring in these patients. Following weight loss surgery, women lose volume and projection of the breasts. Additionally, the lateral breast fold sags and becomes a significant fold frequently extending almost to the midline of the back as the upper back fold. The authors discuss an algorithm for improving the appearance of the breast in postbariatric surgery patients, based on the use of a superolateral parenchymal pedicle (SLPP) and utilizing a modified wise pattern or a vertical pattern with or without prosthetic augmentation to correct specific anatomic abnormalities. The concept of autologous augmentation is utilized to correct specific deformities.