I got 400cc 2.5years ago and now they are too small. I'm considering 650cc and want competent skilled surgeon!

Dear mei2cc,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

After you had your
400 cc implants placed, you required a couple of revisions for bottoming
out.  Now, you are thinking of adding
even more weight with 650 cc implants. 
If you underwent mechanical failure with the smaller implants, this will
happen with the larger implants.  Another
alternative to consider is fat transfer or a breast lift combined with fat
transfer.  If you align your nipple,
breast tissue and implant you can get the projection you desire without a
larger, heavier implant that will lead to multiple operations and failure.  Best Wishes,Gary Horndeski, M.D.

if you had your folds secured with sutures as I would be reluctant to enlarge your pocket in any way downwards due to concerns you will bottom out again.  So if there is an implant profile that will give you the volume you desire without needing lowering of your fold, it can be done.  Otherwise you are accepting a lot of risk if you disrupt your fold to accommodate the larger implant.  Certainly anchoring sutures done at your new fold may help minimize this risk but still, its a significant risk you will have to accept.

It sounds like at some point you may have had some reduction of your natural breast volume? Did you have a lift/reduction at the time of one of your augmentation operations? Augmentation alone always makes the breast bigger so it is hard to piece together why your 400cc HP implants, which is a good size for a lot of patients, let you to feel like you had smaller breasts. Perhaps the weight gain makes you perceive your breasts as too small for your frame now, in which case it seems that upsizing to larger implants may be all you need. If you have bottoming out, it may suggest that you have loose lower breast skin which makes the upper pole projection less perky, especially when you are not in a bra/bathing suit top with support. Exam in the office is necessary to truly counsel you fully but as long as the implant dimensions do not exceed your breast width and nipple-to-fold distance for proper positioning of the implants, you may be able to go up in size to the target you are thinking. Consultation with a board-certified plastic surgeon where you bring any pictures you might have had even before your first operation would be very helpful.

Yes, of course you can go lager. You probably need to go inframammary on both since you will likely need to expand the pockets some to accommodate the larger implant. Don't focus too much on a "number" for the implant. It is a dimensional operation which ends up with the best implant to achieve the visual result you want whether it takes more or less. I have included a short video discussing implant "volumes" versus dimensions.

It is certainly possible to go larger.   Implant size dimensions are based on your chest wall width and the implant projection.   Even on a narrow chest wall larger implants can be achieved with greater projection of the implants and an increased size.   I would caution you about going too large as the skin envelope can be irreversibly stretched.   650cc is quite a bit larger than what you currently have.   Using a 3D analysis camera such as Vectra can help simulate the results.   Many board-certified plastic surgeons use this technology in their practices.  Best of luck. 

Hi and thanks for your question!  Yes you can go bigger but you have to make sure that is the problem first.  I would be very suspicious that your implant pocket has changed to the point where your implants are either too much towards your underarm or too low making the implant appear smaller.  While you can go up in size, if the pocket is not right, it will won't achieve the goals you are looking for.  Best to consult with a surgeon who is familiar with implant revisions.  Best of luck!

Implant selection will depend on your goals and body dimensions. There are many skilled and competent surgeons that could help you with this. Through the armpit does not offer the same control and precision that the inframammary fold incision allows. I recommend using inframammory fold approach for your next procedure.

Choosing the right implants for you requires an exam in person. Your anatomy will dictate in many ways what would be size appropriate for you.

Thank you for the question and pictures.  Yes, adding the volume you mentioned will certainly make a difference but the better question may be: will it be the difference that will achieve your desired outcome.  Sometimes adjustments of the surrounding breast implant capsules are 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 selection of plastic surgeon and careful communication of your goals will be critical.
Generally speaking, the best online advice I can give to ladies who are considering revisionary (upsizing) 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 fake look” or "D or DD cup” or "more full and plump look" 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.