A to D cup with 380 cc saline implants, should I have gone bigger?

Thanks for the question, if you really want to go larger it is important that you understand that the extra weight will eventually win and stretch your tissues more than a smaller implant. If you are ok with that tradeoff than you should discuss a larger implant

Size choice is based on a number of factors: breast tissue thickness, breast base width, patient goals etc.  You could consider a second opinion if you are unsure of your surgeon's recommendation.  Seek a board certified plastic surgeon who is familiar with revision breast surgery.  Good luck. 

The implant size is ultimately one that you have to live with, so you should choose the size you are most comfortable and happy with.  But, your surgeon will help guide you as well.  One thing to keep in mind in this decision is that a larger implant will stretch your thin breast tissue more over time.  Also, you may want to discuss the use of acellular dermal material with your surgeon, since this could decrease your risk of capsular contracture, thicken your thin tissues, and provide support to the soft-tissues of the breast, particularly if you increase the size and weight of the breast with a larger implant.  Best wishes,-Erik Hoy, M.D.