I have Sientra cohesive 435CC mod+, I love the size but want more projection. What size should I get? (photos)

You should change to a HP implant of similar width which would be in the neighborhood of 550cc.  You  don't want to go any wider as this will give you more girth without necessarily increasing projection at all.

Hello and thank you for your question. From your photos, switching to a high profile implant looks like a good option for you. Though I cannot say for certain without an in-person evaluation, I believe it will deliver the projection you want without sacrificing the elements of your augmentation that you love. As for size, an implant with slightly higher CCs will likely make the most sense — this will ensure you maintain the same width at the base of your breasts while adding volume in the dome of the implant for more projection. You will need to schedule a consultation with your board-certified plastic surgeon to look at the implant sizes available and to compare implant widths. Best of luck!

Exchanging implants is unlikely to give you more projection.  The problem is your lift was inadequate and your breasts are not high enough on the chest wall.  The technique I recommend is explantation using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices and half are removed by 9.5 years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Great question!  Going with the high profile implant will definitely give you more projection.  As far as sizing goes, have your surgeon pick an implant that is about the same diameter as the one you have now and looking at the sizing chart you should be able to find the size that best fits your body.Best of luck and hope this information helps!- Dr. Roger Tsai  @DrRogerTsaiBoard Certified Plastic Surgeon

Dear Miamimami2018,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

Good afternoon!Given your current implant dimensions I think your new HPs should be in the 550-600cc range!

Congratulations on your surgery as you have a very nice result.  In your case, if you are happy with the size I would look at what the dimensions of your implants are and plan on finding a more projecting implant and perhaps an implant with more cohesive silicone (Soft touch or Cohesive) as well as an implant that has a higher fill ratio.  Together that can give you the more fullness in the upper pole and more projection but also keep your width that you have.Make certain you see a board certified plastic surgeon that has experience in breast revision surgery.Hope that helps.

I always recommend following "dimensional planning", meaning that the base width of the implant should match breast / chest wall dimensions.  A Sientra cohesive 435cc mod+ implant has a base width of 13.2cm (and a projection of 4.6cm).  Since you are happy with your current size (and breast width), Sientra cohesive 470cc high profile (base width 13.1cm, projection 5.2cm) or 505cc high profile (base width 13.4cm, projection 5.3cm) implants are your two best options.  The 470cc implant will provide a little more projection with a minimal increase in size.I would recommend that you discuss your options carefully with your surgeon, however, to determine if the high profile implant will provide enough additional projection to achieve your goal and justify the procedure.Best wishes.

I am sorry to hear you are dissatisfied with you results.  That being said to say which size you should go to depends on 1) what your ideal look is and 2) what your measurements are.  Its too difficult to say which size but if you want more projection then I would definitely do HP or ultra HP implant. Best of luck to you.

Ultimately,  careful selection of your 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, and computer imaging) will be critical. 
Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation surgery 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 “more projection” or "up a cup size” 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. 
3. Once you feel you have communicated your goals clearly, allow your chosen plastic surgeon to work with you in determining the best plan to achieve your goals.
I hope this helps. Best wishes.