I want to go from 30E to full C cup. Am I being unrealistic? (Photos)

Hello,The mere fact that you use photos of breast augmentation patients, with their tight, orb-like breasts that don't sag as goal pics indicates you will not be happy with a primary breast reduction. Further, talking about cup size is impossible to calculate, much less guarantee as a result. You will need a primary breast reduction, preferable with a small, flat, tall shaped, highly cohesive implant to optimize upper pole fullness. Although this will give you a great result, you may elect to have a revision reduction and lift to further reduce volume and minimize/eliminate the inevitable recurrent sagging that comes with all primary lifts and reduction. Go visit a few ABPS certified/ASAPS member surgeons who specialize in cosmetic breast surgery. Best of luck!

The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

A reasonable plan would be breast reduction and lift procedure on both breasts and then augmentation using a small silicone implant to create some upper pole volume. 

Thank you for your pictures and questions. While I do not think your goals are unrealistic, I think some of the language you are using shows a poor understanding of the process. When you say that you want to remove all your natural breast tissue and replace it with an implant, that is akin to a breast reconstruction after a mastectomy for cancer and is not going to produce the results you want nor is it an appropriate approach to your goals. You need to see a local board certified plastic surgeon to discuss your goals and how to achieve them. I can give you an idea of how I would approach this problem and it may be different from others. I would suggest a two stage approach. The first stage would be to convert you to a smaller breasted patient with a different breast shape and position. This would be achieved through essentially a breast reduction/lift with an anchor type scar and removal of breast tissue and skin. I would image that you would end up as a B/C cup (like some of the starting goal pictures you shared). Then at a second stage 3-6 months later, I would suggest placement of an implant just like a normal breast augmentation to achieve your ultimate size goals. While many surgeons may tell you that you can do everything at once, and technically you could, I think a one stage operation will have a much higher risk of complications and poor scarring and also may not produce the ultimate results you want. Hope this helps!

Dear Nataliepoehler,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, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Based on
your photographs, the best shape and contour could be achieved with a small implant
and a breast lift/reduction.  The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   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.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Why, oh, why would you want to do this???   Your breasts tissue is meant to last a lifetime.  An implant will last only 15-20 years or so and then will need to be replaced and then replaced again.  Also, an implant is a gigantic foreign body that will be recognized as such by your body and will form a capsule.  If you are lucky, the capsule will stay soft for years but if you aren't, you will soon regret having your healthy breast tissue removed.  Look, you are young now and I understand you want a certain look but it is important for to look at the long term consequences of surgery.  You will regret doing this.  Maybe not in 5 or 10 years but certainly in 20 years.  Don't do it.If you want small and perky, that can be achieved with a breast reduction/list.  You may also want to consider having your surgeon use some acelluar dermal matrix like Strattice or a surgical mesh like Seri as an internal bra to help keep you perky.  These are products that are gradually broken down and replaced by your natural collagen tissue over a year or so.  I recently saw an video on another plastic surgeon's Instagram of him first liposuctioning a normal, full breast into a flat tire and then inserting a big old implant.  This, IMHO, is insanity.