Will a Breast Lift and Reduction Be Enough to Keep Breasts Up and Perky?

There are risks to agressive reductions. However, in order to achieve the look you have described, it would best be achieved with an agressive reduction and implants. This would NOT be my advice.

In my opinion you should start with a breast reduction/lift  to get the breasts where you want them on the chest wall. This operation will serve to remove excess skin, breast tissue, and adipose tissue. A second stage breast augmentation procedure may or may not be of interest to you;  this will increase superior pole volume/fullness.

Of course, direct physical examination and a review of your goals will be necessary to give you precise advice.

Best wishes.

The quick answer is that all you need is a reduction.  A breast reduction moves the nipple to a higher and more youthfull position, removes the excess breast tissue and results in an overall more youthful "perkier" appearance. 

You certaily canb have a breast reduction and lift ther breasts at the same time. It does not sound like you need an implant if you are reducing them. But, you will always need a bra.  All things eventually move downward with gravity.

You ask a very intriguing question. But you failed to post photos, so my answer is a well preformed lift/small reduction can produce "perky" breasts. But if after the surgery you still need more perk than a small implant as a second operation.

When a breast reduction is performed, the majority of patients in my practice are getting them for physical symptoms and the surgery is covered by insurance if approved.  That is the first hurdle.  Insurance companies can have very strict criteria for what is considered a reduction.  Things that may be considered and documentation requested include photos, height, weight, Body Mass Index (BMI), previous nonsurgical treatment, prior physicians care.  That is just the beginning.  Then, you must state how much breast tissue will be removed and a weight in grams of breast tissue to be removed must be the goal.  That is an important aspect of this surgery and will dictate some of the answers to the other questions you have asked.  Especially since implants and reduction would not be O.K. with insurance companies.

You state that you would like a perky D cup from a 34DDD.  Unfortunately this is not an exact science.  Both reducing to a certain cup size and the bra to fit are variables that are not precise measures but rather general guidelines.  Manufacturers of bra vary on similar bra sizes and especially when you go above a D.  Some will use DD, E, or F so bra size is at best a guideline. 

To answer your question, a reduction in general includes the lift as a part of the surgery. So every woman who has a reduction will get a noticeable improvement in appearance.  The fact is that the breast will not keep that initial shape since the thinner skin below the breast will stretch and superior pole fullness (the fullness of breast which is lifted above the nipple) will move down and "bottom out."  The key is that if your breast look perfect after the surgery that with time this shape will change time and the breast will appear more bottom heavy.

An implant will help maintain that superior pole fullness as it will not sag with the rest of the breast.  The timing of implant placement in a case like yours varies with doctors.  Since you would like to keep a relatively large breast, I would expect for some bottoming out.  Your plan of reduction first seems reasonable and waiting on any implants would be wise.  This is one of the most difficult aspects of breast surgery.  How to make something bigger and smaller at the same time.  You should be happy with a reduction and time will tell if you desire more.  Just my opinion and good luck

So many patients these days are dictating what they want from breast augmentation, breast lift and reducion surgery to include being "perky" and not needing to wear a bra.  For many body types, this is just unrealistic and that is the case if you are currently a DDD cup.  Your tissue elasticity has been damaged by the size weight and stretching of the breasts that even after a lift and reduction they will always want to be supported.  I'd recommend the lift and reduction first and then an implant if you want more upper pole fullness.  Good luck and be realistic.   "You can't always get what you want..."

No matter the operation you choose, with a D cup breast  you will need to wear a bra or your perky breasts will sag with time because of gravity.  You probably should consider a reduction which involves a lift.  You can always add an implant at a later date, if needed.