I currently have 600cc moderate round implants, how can I keep the width and get upper fullness in a revision?

Hello,Your overfilled device, although labeled 'moderate', is actually quite high profile at this point, with that extra 100 cc of saline making it much higher profiled and narrower in diameter too (as well as unnecessarily firm, a big problem for your languishing tissues being crushed). As I said, you really deserve the benefit of a true consultation with a qualified, experienced surgeon who can set the record straight, examine you, and give you the best understanding of your situation and the possibilities of achieving your goals, if possible. Best of luck!

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Thank you for your question.
I agree with the plastic surgeon who recommended higher profile. You may also wish to consider some Autologous Fat Augmentation and contouring to get the desired results in addition to Breast Implants. All The Best !

Seek a breast revision specialist to evaluate you for best implant to maintain your base diameter and achieve upper pole fullness with a high profile implant

Dear BrittE92,determining the ideal breast size and matching that goal for the patient is the most difficult part of breast augmentation. It starts and ends with the patient. 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 its 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, everyone of them have 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.Daniel Barrett, MD, MHA, MS
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Indeed, you are correct.  High profile implants have a narrower base diameter for any given volume.  This makes it difficult for you to achieve more upper pole fullness without narrowing the base diameter of the implant.  This trade off can still work out depending on the degree to which you change each dimension.  I would discourage you from overfilling the implants beyond the manufacturer's labeling.
Hope this helps.
Dr. Ali Mosharrafa

Thank you for the question.  Although it is not possible to provide you with definitive advice without an person evaluation, most patients are able to "go larger" at a second stage, once the breast tissues have expanded (after first-time breast augmentation).  Sometimes, during this revisionary surgery, adjustment of the breast implant capsules is also necessary to achieve the desired outcome.
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.  
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 "upper pole fulness" 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 helps. Best wishes.

Thank you for your question. The simplistic solution to your dilenma is to fat graft you breast to achieve additional fullness and projection. Leave your current implants in place, and fat graft around it to enhance the areas of your breast where you would like additional volume, fullness, or projection. Please consult a board certified plastic surgeon who is experienced with breast surgery.