Thank you for the insightful question. As you may know, 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. One analogy I used to describe the issues at hand is called the sheet versus comforter analogy. Young ladies who present with very little breast and/or adipose tissue “coverage” (analogous to "sheets") are more likely to achieve the “full, round” look with breast augmentation surgery since the breast implants will show themselves through the relative thin coverage present. On the other hand, patients who present with more breast and/or adipose tissue coverage (“comforters”), are less likely to achieve the full round look after breast augmentation surgery, because the “roundness” of the breast implants does not show themselves through the relatively thick overlying coverage. The best online advice I can give to ladies who are considering revisionary 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. For patients seeking the "fake look", the use of over filled saline or ultra high profile silicone gel breast implants may be very helpful. I hope this helps. Best wishes.