How do I get the very high fake look? And how do I get it to stay that way? (Photo)

There is nothing wrong with liking the look you want, but you must understand that many if not most women who actually have this look either are in a bra or swim top like your one example, or actually have capsular contracture (CC) causing their breasts to look high and round, but ALSO to feel like Tupperware bowls or croquet balls under their skin.I have always told my patients who want this look that large and high profile is not the answer as reliably as a good push-up bra (and having enough breast volume to actually push up).A donut mastopexy, especially in dark skin, will frequently leave you with wide, puckered, irregularly-pigmented, and ugly scars with flattened breasts and not much "lift" or tightening at all. Especially with large(r) implants stretching your skin and areola scars as they heal and mature. Look at how you demonstrated the "look" you desire--you used your hands to push up your breasts (plus implants). So does your second goal photo--swim bra holding up the breast (plus implants) volume. I'd bet you a can of Diet Mountain Dew your first goal photograph has hard capsular contracture, or is early after her augmentation and has young, tight skin and muscles--and in a few months will sag a bit like you.Your breast skin has stretched with the present volume (actual breast tissue plus implants) you have, and going larger is not possible except with overfilled saline implants, so I understand your idea to tighten the skin via periareolar (donut) mastopexy. It's just that it won't work, and you will again be unhappy. Even if your scars are "perfect," your skin cannot suddenly become more taut and less stretchy. (Unless, of course, you develop CC.)Please understand that I tell you this not to disappoint you, but to try to make you understand realistic expectations. Too many plastic surgeons may think they can "guarantee" that they can give you just what you want. How much will you spend and how many disappointments will you suffer before you realize that at least someone (me) is trying to tell you what I feel is not only the truth, but the likeliest outcome. I'd suggest a few more consultations with senior plastic surgeons who are ABPS-certified and ASAPS members with large breast practices. Talk to the breast implant reps in your area to find out who those doctors are; don't ask the doctors themselves--we'll all tell you how many hundreds we do per year! Best wishes! Dr. Tholen

if your breasts sit low to start or if you have a lot of breast tissue to start it's hard to get the high round look. This look is easier to obtain in patients that start as an A cup and have breasts that sit very high. 

Thank you for the question. Definitive advice would require more information or in person examination but some of general thoughts may be helpful to you.

Generally speaking, patients seeking a "round fake look" or "high profile augmentation" may or may not be able to achieve their desired outcome. Much depends on the patient starting point.

For example, if the patient has a lot of made of breast tissue present prior to surgery, it may be more challenging (or impossible) to achieve the rounder/fake look, compared to the patient who starts out with very little breasts/soft tissue initially. In other words, the patient with less tissue coverage will likely see the round "implanted" look ( achievable with higher profile silicone gel implants or overfilled saline, for example). In these cases, removal of native breast tissue ( breast reduction as well as breast lifting) may be necessary. You may find the attached link, dedicated to many of these concerns, helpful to you as you learn more. Best wishes.

Dear Bayes1981,The unfortunate reality of large implants is the they are heavy and your tissue is always bound to stretch with time. I would venture to guess that many of the photos you like are early (not years) after surgery, or the bra is positioning the implants slightly higher and medially. You could consider changing to a textured implant in a neo-subpectoral pocket to help prevent descent of the implants, but gravity may always win. I'm sorry but I don't have experience on the internal bra so maybe other doctors can advise you on this.

The fake breast look can be achieved in several ways, depending on what you want your eventual size to be. If you want to have less than 1400cc XL breasts, then I do 800cc saline implants(largest shell size available in US) and overfill them. If you want to be largerr than that, then I recommend my XL custom tissue expanders which can be filled to much larger sizes. At same time you may need some type of uplift. I recommend that you visit my site esp for XL breast implants for further explanation of different alternatives. My specialty for many years has been XL breast implants. I also recommend that you go to a plastic surgeon that has extensive experience in these sizes to get the best results for problems can occur and more frequently. I also do revisional surgery on XL patients. I offer SKYPE/FACETIME/What'sUp consultations which can be arranged through my XL patient coordinator(Rachelleatsurgery-plastic.com). 

The implants you have weigh nearly 2 pounds each and are supported only by skin. Even if they are "under the muscle" the bottom of the implant is not. Skin is weak and stretches. If you ever had a pregnancy or had large weight loss which left your skin damaged, the skin is never going to be able to support those extreme implants. And the longer they are in the thinner and less strong your skin gets. An internal bra may help, but your predicament is why so many of us do not perform the operation to get those results as the damage created may not be able to be corrected.