The present study reports on patients who underwent breast reconstructions with extra-projection implants. Two-hundred and thirty-four women were treated for 238 breast reconstructions irrespectively of breast shape and size. In this series we aimed to reconstruct for all women a bilateral cosmetic medium-size breast (between 400 and 500 cc), highly projected, with a little to moderate ptosis rather then a ptotic one exactly matching the contra-lateral. This is demonstrated by volume of implants that ranged from 397 cc for ladies with small breast who received an augmentation, to 533 cc for those who side required a reduction surgery. Eighty-six percent of patients received contra-lateral procedures. Complication rate was 8.4% and 66% of reconstructions were rated as good in the patients' opinion. Extra-projection implants, coupled with contra-lateral breast surgery, provide a good aesthetic outcome and avoid myocutaneous flaps only on the basis of breast size and shape.