I currently have 445cc silicone implants and would like to go bigger to a full D. Advice? (photo)

There is no correlation between bra size and implant volume. Besides cup size is irrelevant, what will make you happy is seeing a particular proportion in the mirror or photos, not the tag in your bra. Any surgeon that would even suggest that they can deliver a particular cup size is either not being honest in their inability, or just living in fantasy land. Sizing using purpose built sizers or rice sizers (home made), are the best way to see how you would look. However, looking at your photos, it appears that there is precious little room for any larger implant. especially one that is 200 cc large. You are maxed out, and should know that the number one reason for unplanned reoperations are placement of implants that are too large for the patient's anatomy. You're at or very close to your limit. 

Your doctor is correct.  I usually tell my patients that it takes 150-200 cc's more to get one size bigger.  The numbers sound big but that's what's needed for a cup size.

Dear user9702,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

It really depends on the person and there is no real formula to going bigger and how much is needed to go bigger.  In some patient 180cc is what is needed to go up one cup size and other it may be two.  It also depends on where you get sized.  I would not dwell on cup size at this point.
There is obviously a look you are after and photos of what you want to look like would help best.  In addition, sizing in the office would also help.  I would also want to know what profile implants you have as it sounds like you have Natrelle/Allergan.
I would also make certain you are seeing a board certified plastic surgeon.
Hope that helps.

You have a great result. Going up in size is simple to do although it does cost. I think anything over 600 cc’s is far too large and have seen many women go that large and later say “what was I thinking?”.

The suggest sizes are very large and heavy implants that over the long term may not be best for your frame and tissue. With large implants come more risks, especially of sagging and thinning your tissue. You might want to consider a size that is somewhere in between--500 to 550 cc's. Please discuss your concerns with your surgeon. Also, bras are not designed to standardized size.

There is no accurate/reliable/predictable correlation between size/profile breast implant utilized and cup size achieved. For example, I do not think that the generalizations of "200 cc equates to 1 cup" hold any validity or are helpful in any specific or practical way.  In my practice, I ask patients not to communicate their goals, or evaluate the outcome of the procedure performed, based on cup size references.
Ultimately, careful selection of plastic surgeon and  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.IfGenerally 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 "bigger" 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.
 Best wishes. 

thank you for your question. The number of cc does not determine cup size. Cup size is a ratio between your circumferential  band measurement and your circumferential nipple measurement. For instance if you go to Victoria secrets, their 38D is significantly larger than a 32D cup bra, but both are considered D cup bras. I recommend finding a sizer close to your current overall breast size,  then look at  either 100cc or 200 cc larger to see how much larger you wish to go. Best of luck with your procedure.

Thank you for the question and photo and size is an individual decision based on measurements and putting sizers in a bra till you see the volume on your chest that you like.   That said 200cc’s may move you 2 cup sizes larger.   But don’t dwell on cup size but the volume that you like after sizingDr Corbin

Your result looks excellent and you need to understand that while revisions almost always work out, in a very rare case, they might not ie infection, bleeding, unhappy size etc. Generally going up 100 ccs will be a visible change, 200 ccs will be a more substantial change. You can't judge by cup sizes.