Hello

An actual cup size is difficult to predict with a breast reduction.  A lot of it depends on how much can be removed while maintaining nipple viability and sensation.  If nipple sensation is not a concern, or if getting to the smallest size possible is your goal, then removing the nipple as a free skin graft can be done, the size of the mound reduced, and then the nipple replaced as a graft that will not have sensation.

One other factor to consider is that a at chest size of 40, we occasionally see patients that have been reduced significantly and yet the actual size may still be a D cup.  Some of it has to do with the fact that many patients who wear a 40 bra size have some chest fat and axillary fat that contributes to the size, but it is not addressed by reducing the breast size.  Only weight loss can reduce the other components.

Consult with a bard-certified plastic surgeon and bring those concerns up during your talk.  Viewing photos of previous 40 DD patients would also be helpful in that discussion.  Best of luck.