A 48-year-old woman was working as a hostess in a lounge and was struck in the chest when a fight arose; afterwards, she noticed discomfort and a warm sensation in her left breast, which over the course of months remained smaller and also became distorted in comparison with her previous size, shape, contour, and comparison with her right breast. Ten years previously, she had received double lumen prostheses (saline on the outside and silicone gel on the inside). One year later she was found to be at maximum medical improvement (MMI) and described no signs or symptoms although her sexual life reportedly changed, with less frequency and satisfaction. Tables present the fifth edition criteria for rating permanent impairment due to skin disorders; fifth edition criteria for rating permanent impairment due to facial disorders and/or disfigurement; and sixth edition criteria for rating permanent impairment due to mammary disorders. Section 10.9 of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, mentions that coexisting psychiatric impairment would be rated using the mental and behavioral disorders chapter, which contains one reference to cosmetic abnormalities and requires a “severe cosmetic deformity with no ability to lactate.” Thus the only way to provide an impairment rating using the fifth edition for this individual is to perform a psychological evaluation; in the sixth edition, it is the only permissible rating.