Breast Reduction, Lift and Implants to Get C Cups from DD Breasts?

With large (DD) breasts that are pendulous (droopy), I would recommend a small breast reduction with a vertical incision technique.  I believe this will give a satisfactory result.  If you are unhappy with the appearance of your breasts after this procedure, you can always come back and place implants in a second operation.

It is possible to perform a breast reduction with implants. This is necessary when we not only want to remove the excess skin and tissue but want to create fullness and projection to the breast.
In all of breast surgery, this combination is the trickiest. For this reason it is essential that you work only with a board-certified plastic surgeon who has a great deal of experience in breast reduction, breast lift, and breast implant surgery area. Their expertise and depth of experience is crucial to help you achieve a good result.
 

Breast implants add volume (and weight) to the breasts while auto-augmentation really does not.  Additionally, implants augment the entire breast, while auto-augmentation augments the upper pole only.  So for many reasons auto-augmentation results tend to be less prone to recurrence of droopiness.

Other advantages of auto-augmentation mastopexy:

                #1 - Zero need for implant surveillance and possible replacement

                Also:

Zero risk of capsular contracture

                Zero risk of implant migration / malposition

                Zero risk of visible fold/ripples

                Zero risk of implant infection

Auto-augmentation mastopexy is absolutely the procedure of choice for a patient who wants a breast lift, who will not have adequate upper pole fullness without an implant or auto-augmentation, and who is happy with the amount of breast issue that she is starting with.  If a patient wants a lift AND fuller breasts (i.e. increase in true cup size), then an implant is required.

It is important to understand that there is no plastic surgery procedure for which the results do not change over time.  Skin is elastic and stretchy and so is breast tissue, and that ‘stretchiness’  increases with age.  The elasticity of skin and soft tissue is genetically determined, and it therefore varies widely from patient to patient.  So it is impossible to predict for any one patient how long it will be, if ever, before they feel they need a secondary mastopexy – which in most cases is just a touch-up procedure and not nearly as extensive as the original mastopexy.  Certainly if a patient has breast stretchmarks and thin breast skin from multiple pregnancies, then that patient is more likely to need a secondary mastopexy at an earlier date than a patient with thicker skin and better skin and breast tissue tone.

Web reference: http://www.michaellawmd.com/gallery/breastlift1.html

Experiencing significant drooping with larger breasts is very common. Reduction alone often isn’t enough to get the high, perky breasts that are the goal of most women who want breast reduction surgery, which is why we so often include a breast lift at the same time. If you have natural DD cups, I don’t think there’s any reason you would need additional implants after the reduction to end up with a final C cup. The breast lift reshapes and firms the breast tissue to meet your appearance goals. Bring in some photos of the look you want to achieve to share with your surgeon, and he or she should be able to get you there. As for expense, many health insurance companies will cover the cost of a reduction, so be sure to check with your provider and see if this is an option.

You may be a candidate for a short scar breast reduction which minimizes scars and improves contour of the breasts. Raffy Karamanoukian Los Angeles

Web reference: http://www.surgery90210.com/breasts/6/breast-reduction.aspx

When women with breast hypertrophy undergo breast reduction surgery they typically have multiple goals. These women are not only interested in reduction of their symptoms, but are also concerned about breast aesthetics.
In the vast majority of patients who undergo breast reduction the aesthetic results are excellent. The procedure reduces breast size, reduces areola size and lifts the breast into normal position.  In most patients, this results in alleviation of symptoms and improved breast aesthetics.
Most patients are happy with their upper breast fullness following breast reduction surgery, but over the course of time some patients note loss of fullness in this area. Under these circumstances placement of a breast implant may be necessary to correct this problem.
  Based on your history, I would recommend a breast reduction without breast implants. In most cases this would give an excellent aesthetic result with upper breast fullness. If inadequate upper breast fullness becomes a problem, a secondary breast augmentation can be performed at a later date.

My advice depends further on an in-person consultation, but judging from your description and photo, it looks like having this combination of procedures is not necessary.  You would probably do well with just a breast reduction operation, which will lift the breasts at the same time.  Implants shouldn't be necessary to get the results you are looking for. 

A great breast reduction technique for a woman with breasts of your size that will provide nice lift is the short-scar technique.  This will also reduce scarring and usually provides patients with a shorter recovery time.  In terms of cost, it varies depending on what you and your surgeon decide to do for your surgery, but we do have good success in getting insurance companies to cover breast reduction procedures, at least partially.  I hope this helps and please don't hesitate to contact me with any questions!