Julie:
That was a very good response, and lays out the issues of specifically MTF breast augmentation.
I have a very large thorax (44 inch), and my surgeon, Dr. Z, recommended high profile saline implants, and he recommended that I have a large cup size, a D cup (650 cc). His reasoning was very similar to what Julie described. Because I am a large economy sized woman, anything smaller would not have given me as good a profile.
At first I was aghast at his recommendation. By the time I had my consult with the doctor, I had developed about an A+/B cup and I had envisioned myself having a C cup implant. Also I had thought about having a teardrop shape, not a high profile, bowl shaped, implant.
I gave his recommendation a lot of thought and spent some time wearing D cup sized breast forms to see how I would look. I had thought that if I had such a large sized BA, that I would look like Dolly Partton or some over-the-top cross-dresser. But that was not the case. No one noticed that I was larger and I felt that my clothes fit better.
What he stated was that the BA would be place high on my chest wall and over a period of months, they would eventually descend to a normal place on my chest and my profile would be quite feminine. And he was right.
Had I gone with a smaller teardrop shape, they would have descended and my overall profile would have been less because my breasts would have appeared smaller on my thorax.
With the high profile style, they now look quite nice, at least they do to me and the clothes that I wear make a very nice presentation. But as Julie mentioned, I have no cleavage to speak of and that is again because of my size. And if you observe other large women you may notice the same thing.
I did go back about a year ago and have a touch up to bring my girls closer together, which the doctor did say may be needed.
Without any clothes on, yes, you can discern that I have had a BA, but very few ever see that. My self esteem has been raised dramatically because I feel good wearing the clothes that I do and that is really the point for me.
-Sandy