What's your opinion on 495cc high profile or 515cc moderate plus for my implant exchange? (Photos)

Thank you for your question and your photos.  We typically choose the profile of your implant based on the measurements of your natural breast width.  With little breast tissue to cover the implant but not wanting a lot of upper pole fullness, I would recommend the Allergan Silicone 2 gel implant which is slightly more cohesive than a silicone 1 to lessen the chance of seeing any rippling.  I definitely recommend that you consult with a board certified plastic surgeon who can show you the different types of implants available to you and also do some sizing to determine how many cc's you are wanting.  I hope this was helpful and best of luck on your search!

Great question!  Implant selection can be a complex issue.  Without seeing a photos of what you look like, it is hard to provide any recommendations.  However, understand that high profile implants will give you a more round and fuller upper pole, while a moderate plus will provide you with a more natural upper pole fullness.  I would follow the recommendations of your surgeon after showing him/her your wish photos.Best of luck and hope this information helps!
- Dr. Roger Tsai  @DrRogerTsai
Board Certified Plastic Surgeon

My best advice: more communication.
It is definitely worth spending more time (prior to the date of surgery) with your plastic surgeon to discuss further.  As you know, it will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
One question that might be helpful for you to consider: would you be more disappointed if you are slightly too big or slightly too small after the breast augmentation procedure?
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, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
Generally speaking, 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 “natural” 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 for an outcome that you will be very pleased with.