Currently 40DDD and want to be a C cup. Surgeon said he can't safely make breasts that small - why?

Breast reductions may be limited by the preop degree of sagging. When performing a breast reduction, the nipple usually is attached to a pedicle to maintain blood supply to the nipple. If the nipple has to go a far distance to get to the new position, there may be limitation to the amount of tissue removed and ability to keep the nipple viable.
Plastic surgeons often don't guarantee a cup size- each bra is manufactured differently and each patients anatomy is unique.

Hi,
Thank you for the question.
Based on what you are describing, it does sound that you have large/heavy breasts causing physical symptoms, and breast reduction may be an option for you. However, it is difficult to tell without seeing the photos and/or in person consultation.
During breast reduction surgery, excess breast tissue is removed, the breast is lifted and nipple/areola is typically made smaller. It is easiest to think of breast reduction as including the breast lift.
Schnur Sliding Scale is a scale used by many insurance companies as a guideline for how much breast tissue should be removed in order to improve your physical symptoms. In addition, most insurances in order to approve the surgery, will require for 2-3 letters of medical necessity (from your chiropractor, primary doctor, OBGYN, Dermatologist, etc) demonstrating that your physical symptoms due to large breasts are not improving with conservative management.
The goal of breast reduction surgery it to make the breasts smaller and lifted, but also proportionate with the rest of your body. It is reasonable to to expect full C/small D cup breast size after the breast reduction surgery.
I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Breast Reduction surgeries to further discuss your options, specific techniques, concerns and expectations. Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzBreast Fellowship-TrainedBoard Certified Plastic Surgeon

It's difficult to determine exactly why the surgeon felt you weren't a candidate to reduce to a C cup size without an examination. It could be due to the size or width of the breasts. It also could be the quality of your tissues. Maintaining adequate blood supply to the tissues is essential during this procedure. Removing too much tissue can compromise this. I encourage you to call back to speak to the surgeon again for further clarification.