Do I need a doctor specializing in XL augmentation with 'fake' look, sometimes referred to as 'bolt-ons'? (photos)

Choosing an implant based on an aesthetic goal that exceeds your anatomic capacity may lead to complications and possibly revision.  Very large breasts have the natural tendency to sag or hang low.  Please go to a board certified plastic surgeon who can assess you with physical exam and make appropriate recommendations.Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Thank you for your questions. I pity the doctor who advertises that they specialize in "bolt-on" breast augmentation, because that is a sad day indeed. The goal photos you share are all women who are extremely skinny and have very large and highly projected implants, usually placed in front of the muscle to accentuate the fake look. If you are looking to achieve this, then you should discuss with your surgeon that you would like to choose the largest implant possible for your base width measurements. However, your starting point is different, so your ultimate outcome is going to be limited by your own anatomy. In addition, do not be surprised if surgeons try to talk you out of overly large implants for your frame because we know that while things may be fine early on, overly large implants result in early return to surgery for revisions over time due to the changes exerted on the breast tissue.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Thank you for the question.   Much of the final outcome achieved with breast augmentation surgery depends on the patient's anatomic starting point.  In some ways, it may be more challenging to achieve an "fake look" when patients start out with a significant amount of native breast tissue.  Having said that, it is usually possible with careful dissection of breast implant pocket (I generally prefer the sub muscular pocket for most patients, including patients who are looking for a larger or more fake look)  and careful selection of appropriate breast implant type/size/profile to achieve the "fake" look.Patients attempting to achieve the "fake" look often benefit from the use of  higher profile silicone gel breast implants or overfilled saline filled breast implants. Adjustment of the breast implant capsules (capsulorraphy) may be a very important part of the procedure as well.  The adjustment of the breast implant capsules may keep the breast implants higher on the chest wall and prevent displacement when patients lie down.
 The best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, 
I have found that the use of words such as “fake look” or "D or DD cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes.