Here's what I did:
I got a straw wreath like this one and left it in the wrapping.
I pinned and I pinned. And I bought some more balloons and pinned some more. I filled it in until I liked the look of it.
And to be honest, I didn't fill in the sides. So if my wreath is hanging by the front door for someone's birthday and you aren't looking at it straight on, you will see part of the wreath underneath.
But I'm okay with that. For a finishing touch, I added a fun "happy birthday" flair that I'm pretty sure I got by the gift bags at Winco.
And that is our birthday wreath!