PS said I can't go over 397cc (possibly 421cc) due to risk of symmastia. Any alternatives? Incredibly disappointed. (Photo)

Thank you for your question and for providing the photos.  The implants that you mentioned, the 397 and 421cc implants are both moderate plus profile implants.  If you are hoping to have more volume, a high profile implant may be an option.  It sounds like your plastic surgeon is concerned with the width of your breasts in relation to the implants.  If an overly wide implant is used, a symmastia is a possibility.  A high profile implant allows for more volume at the given width, which can create a larger breast.For example, if you are limited to a 13.1cm width, which is the width of the 397 cc implant that you are considering, a high profile implant of the same width could be used.  The 500cc high profile implant has a width of 13 cm, and would therefore allow more volume and be at no more risk for symmastia than the 397.I would suggest discussing the high profile implants with your plastic surgeon.  It may be an option for you, though an in person exam woould be needed to make a definitive assessment.Best of luck with your breasts.Jeff Rockmore

High profile implants may be beneficial to give you the volume you want without increasing the implant diameter. Discuss this option with your surgeon. There may be a valid reason that he did not mention them at your consultation.

Viewing you pictures I don't see any reason that you couldn't go with a larger implant.  Do some research and get a second (or third) opinion. All the best to you!

If you wish for a larger implant and are not on the same page as your surgeon, you owe it to yourself to obtain a second opinion.  From experience after 16 years and several thousand breast augmentations, many of my own patients will have seen more than one surgeon.  Most reputable surgeons have your interests in mind an want you to achieve your best self. Reviews online are important, but not the be all end all.  Does your surgeon have privileges to do these procedures in the hospital, is he/she published on cosmetic breast surgery, can he/she help you if there is problem?  Look around, ask your friends and get a second opinion.

I think your surgeon is thinking of your best interests.  More projection with less increase in diameter can be achieved with high profile implants.  Whether they would work for you depends on the dimensions of your chest.

Your
surgeon is wise to let you know the possible risks of choosing an implant
that’s too large for your existing breasts to properly support, and that could
compromise the surgical pockets enough to cause symmastia. The best breast
augmentation results aren’t just about how you’ll look right after surgery, but
also need to take long-term outcome into consideration. By recommending a
smaller implant, your surgeon is looking at many different factors. If you have
your heart set on a particular volume, check into the possibility of high
profile implants, which can give you a very dramatic look even though the
overall volume might be smaller. A tool like Vectra 3D imaging can help you
visualize your results better.

It is difficult to accurately size a patient outside the operating room.  I generally have my patients try on sizers to get a feel for their goals.  But it does not necessarily render the size I will use to achieve those goals.Indeed your anatomy is largest factor in determining what size implants to select.  For patients wishing a larger size implant certain techniques can be employed such as subglandular augmentation with shaped ultra-high profile implants.  That way the increased volume is dedicated more to projection than to width.  Excess width can produce synmastia and is unattractive.Ultimately you and your plastic surgeon should discuss your goals and the methods by which they can be achieved as well as the potential risks of those methods.I hope this helps. 

I think that you need to be seen in person to be properly sized up.  Without an exam it is difficult to say. Best of luck.

I see NO issue using 500 cc UHP implants pin this presented case. Maybe you need in person second opinions... 

Thank you for the question and pictures; I think your goals are realistic and achievable but (despite good intentions) online consultants will not be able to  very helpful.  Careful measurements, dimensional planning, and careful communication will be key.   
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.  Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or 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" 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.   Therefore, I ask that my patients not base their communication preoperatively OR  their satisfaction with the outcome of surgery postoperatively, on achieving a specific cup size. The use of computer imaging may be very helpful during this communication phase.
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.  The use of temporary intraoperative sizers, viewing the patient's breasts in the upright and supine position, are very helpful during the breast implant selection process.
I hope this, and the attached link (dedicated to breast augmentation concerns), helps.  Best wishes.