Why Won't Doctors Accommodate D Cup to B Cup Breast Reduction?

Though it is difficult to give you a straight answer without an exam, it is usually quite easy to give patients a B cup from a D cup. Perhaps your particular breast and chest wall shape prohibit such a reduction, but we are able to do that on most patients pretty easily. I would continue looking for doctors in your area.
I hope this helps.

Thank you for your question.
Many patients electing to have a breast reduction will consult with a plastic surgeon with a specific cup size goal in mind.  Unfortunately, there is no way to ensure or promise a patient a specific cup size because cup size is a fairly obscure definition, as cup sizes vary between bra manufacturers.  
To this end, the conversation becomes one surrounding what sort of cosmetic result the patient is hoping to achieve.  Does the patient want a slight, moderate or severe reduction in size?  Are they looking to be as small as possible?  Do they really just want to be lifted and have a more youthful breast shape that will require removal of only the smallest amount of breast tissue possible?  These are the types of questions worth reviewing to ensure that you and your surgeon of choice are on the same page with regards to the patients goals.  
Lastly, there is a limit to how much breast tissue a surgeon can remove at the time of a breast reduction.  It is necessary for the surgeon to leave enough tissue surrounding the breast pedicle in order to prevent loss of healthy blood flow to the nipple, which could cause the nipple loss.  As a result, there are some instances when a patient cannot be made as small as she would like because it would mean compromising the health of the nipple and ultimately the cosmetic result.
I would recommend consulting with a board certified plastic surgeon who is well-experienced in breast reduction procedures.  They can perform a physical exam and help to define how much of a reduction you can reasonably expect based upon your current anatomy.  I hope you find this helpful and I wish you the best.

This should certainly be possible, but there may well be reasons why it is not being recommended.  Common limitations on breast reductions include operative risk, certain technical limitations,, compromised blood supply to the remaining breast/nipple complex, or maybe not enough tissue can be removed in order to qualify as a breast reduction for insurance payment purposes.  Ask your surgeon why.

Hello! Thank you for your question. In general, breast size does not correlate with bra cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory (e.g, incision, lift, use if implant, etc). I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative planning and creating the most aesthetically-pleasing breast for you. Hope me that this helps! Best wishes for a wonderful result!

It’s not unusual for breast reduction patients to start out with D cups and end up with B cups.  This is a common scenario in most plastic surgery practices.
I suspect that the surgeons that you have seen, are reluctant to guarantee a cup size following breast reduction surgery for a variety of reasons.
It’s not unusual for cup size to be defined differently by different people.  Patients frequently know their bra size and confuse this with their actual breast size.  This can cause confusion because different bra manufacturers label their bra sizes differently.  This can make cup size discussions between surgeons and patients difficult.
The surgeon must also deal with patient safety issues.  Attempts to over reduce the breast can potentially damage the blood supply to the nipple areola complex and lead to an increased complication rate.  In addition, insurance carriers may have weight removal requirements as well, which may ultimately affect cup size.
For all these reasons, most surgeons are reluctant to make guarantees regarding cup size, and prefer discussing broader aesthetic goals.  These include shapely breasts with good contour that have proportion, balance and harmony with the surrounding structures.

This can be accomplished, although there are no precise bra measurements to determine cup sizes.  Most surgeons will give you a range of excision- low, moderate, and large excision.  I like to excise enough to have the breasts look aesthetically pleasing.