Breast augmentation: big, round fake look needed. Saline vs silicone, submuscular vs over muscle?

In general, you will have to make some tradeoffs based on the limitations of your own anatomy.  Without being too specific, evaluation of your breast tissue/skin envelope is important to determine what you can support.  Beyond that, you will increase the risk of wrinkling, sagging, etc.  It really is dependent on what you are willing to tolerate.  If you really have minimal breast tissue, placing large implants on top of your muscles will exaggerate all the problems.Best Wishes,nana Mizuguchi

Thank you for the question. You will find that online consultants will not be able to provide you with specific advice in regards to selection of specific breast implant size/profile. Having said that, it is generally necessary to utilize high or ultra high-profile silicone gel breast implants or overfilled saline breast implants to achieve the types of outcomes you demonstrate with the goal photographs. Adjustment of the breast implant capsules may also be necessary.

Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical.

Generally speaking, 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. I have found that the use of words such as “natural” or "D or DD cup” or "big, round fake" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.

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). Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select the best breast implant size/profile for the specific patient.

I hope this, and the attached link (dedicated to larger breast augmentation surgery concerns), helps. Best wishes.

There are several ways to get the fake look-either with overfilled saline implants, custom XL silicone implants or XL tissue custom expanders.It depends really on what cc size to want to get.
You can think of a saline implant as a balloon. The manufacturer recommends an overfill of about 20cc but they have been shown to be able to be filled much more than that. They do start loosing their shape and can significantly distort the appearance of your breasts. 
 I do overfill espcially since the FDA has restricted saline and silicone implants to a maximum saline shell size of 800cc and maximum silicone size of 800cc. I do not know why that number was picked arbitrarily. 
So, I do do breast reconstructions greater than that with XL tissue expanders which do pride a greater diameter and projection and upper pole fullness and allow the size to be adjusted either up or down. Also, the shell of the saline implants are very thin and can dreflate more easily. You may want to visit my site below which explains everything, esp for XL sizes which is my specialty, either initially or revisional surgery.