BA revision scheduled in a week. I'm currently with 325cc mod+ Sientra that I've had for 8 years. Wavering on implant size.

I would be very cautious with upsizing without having a conversation about some type of implant support and/or pocket tightening. I would recommend finding a board-certified plastic surgeon (American Board of Plastic Surgery) with extensive experience in facial aesthetic surgery.

Dear mlivin,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

You are bottoming out with these implants so I do not recommend going larger. You may need mesh for better support and your lower pocket lifted. Once your lower pocket is lifted, you will have more upper breast fullness.

This response was dictated using word recognition.
I apologize in advance for potential. Grammatical errors.Breast augmentation outcomes are based on three variables. The first is patient candidacy. The second is implant selection in regards to shape size and type.
The third is the surgeons ability to place the implant in the correct an atomic location.
Your picture is a bit limited, but based on that it looks like you have significant diversion of your right breast, and your breast sit wide on your chest wall.
Your current implants also look like their bottom out.
This is most likely due to how your previous procedure was done.
Each plastic surgeon has their own way of guiding patients to implant selection.
Some plastic surgeons do this better than others.
Some plastic surgeons ask patients to make implant selections and other plastic surgeons will choose the implant based on input from the patient.
My personal preference is to make the decision based on seeing lots of before and after pictures that the patients have selected, indicating the look, they’re trying to obtain.
I typically use temporary sizers during surgery to make the selection for the implants.
I usually have a full section of implants available during surgery and use size to determine what size and shape implant will give an outcome consistent with the images my patients have showed me as being ideal.
In your case, I think it’s important to address the position of your current implants because they’ve bottomed out.
It’s also important to understand that patients who have breast divergence are going to amplify the appearance of divergence with projection of implants.
Selecting excessively, large implants, increases the chance of undesirable, side effects, complications, and the need for revision surgery.
You already have issues with your implants bottoming out so simply choosing larger implants is going to set you up for problems down the road.
I’m not sure what your discussions were with your provider during your consultation.
My best recommendation is always to focus efforts on provider. Selection has been the most important variable.
In the hands of the right provider, you’ll get a quality assessment, and the likelihood of a quality outcome is higher.Quality assessment should include a thorough discussion about current issues, and your personal candidacy for reaugmentation , which is not ideal currently.It’s difficult to give you a quality assessment based on limited information.
I generally always recommend patience. Have multiple in person consultations with providers in their community well in advance of having surgery.
There’s no correct number of consultations needed to find the right provider repaired.
The more consultations you schedule the more likely you are to find the better provider for your needs.
A quality provider should give you an accurate assessment, including guiding you through the implant selection process without leaving you hanging.
Best,
Matt Hagstrom, MD