Do you think saline will look and feel fake when going from small A to large C and with breasts initially already far apart? (Ph

Thanks for your inquiry and pictures.  I believe the gap between your breast can be diminished with either saline or silicone implants, good luck.  

Hello,
If you have to wait then do so.  You would benefit from a highly cohesive silicone gel implant to minimize your risk of visible rippling. Best of luck!

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

It is important for patients to understand that augmentation will "augment" all aspects of your anatomy. The spacing of the footprints of the breast on the chest wall will vary from one individual to the next. Widely spaced breast will appear more widely spaced and vice versa. 
The spacing (cleavage) is defined by the pocket. The pocket is defined by the plane of augmentation.When placed submuscular, the medial/middle limit is the sternal origin of the muscle. Wide sternum = greater separation of the breasts = less dramatic cleavage. This space can be narrowed (with some risk of symmastia) when the devices are placed subglandular or "over" the muscle. There is no muscle obstructing a medial push, however, there is a higher risk of over-dissection and mid-line migration of the implant (the dreaded "uni-boob").
With respect to your specific question, saline implants, in and of themselves, will not compromise your result. There is a less natural feel and a higher incidence of rippling (as compared to silicone). However, none of these factors will affect your cleavage/spacing. Cleavage is defined by anatomy (as described above). The question of "fake vs. natural" is typically a function of staying within the footprint (BWD) of your native breast.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Dear reggie89,breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Thank you for your photo. Saline and silicone can both appear very natural, and when done correctly, help improve the cleavage even with wide-spaced breasts. Generally speaking, I find more patients feel that silicone has a more "natural" feel. It is best important to have an in-office evaluation where careful measurements are taken of your chest and breast tissue to determine the best range of implant shapes and styles that will be appropriate for your goal size and look as natural as possible. Hope this helps!Johnson C. Lee, MD Plastic Surgery

Good question. Much of the final look and feel achieved after breast augmentation surgery depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” will be optimal. 
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant.
3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. In other words, if a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.  I find that I use round smooth silicone gel breast implants for the vast majority of patients who seek breast augmentation surgery.
4. The size and model of breast implant used may make a significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C or D cup” etc is not helpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
  To summarize: select your plastic surgeon carefully. Communicate your goals carefully as well.  Chances are you will be very pleased with the outcome of breast augmentation surgery. 
I hope this helps. Best wishes. 

so find a surgeon who uses them 'off label' and you can get your gel implants.  As for you wide space, you need to make sure your surgeon is willing to place the implants more medial than directly centered under the nipples but this does shift your nipples more lateral so you have to be accepting of that.  If you center implants under the nipples,  you will still have a huge gap. 

Hi,Saline implants are not as soft as silicone. You are thin and rippling is more noticable in thin patients. With that in mind be realistic with what your results will be. You can decrease the space between your breasts with breast implants. I would make sure your doctor explains to you what he/she expects your outcome to be then you will not be disappointed. Yes, you can have a great outcome with the right technique. Best wishes!

Yes!! Saline breast implants feel like a balloon filled with water, and silicone implants feel like a balloon filled with jello.