I perform a large number of breast reductions and I would counsel the patient carefully into why trying to reduce her to an "A" cup would NOT BE RECOMMENDED. It is never good to go to extremes. Many patients that are quite large breasted can't wait to be smaller and they say things like "make them as small as you can". I agree the breast has to be properly proportioned to the patient's frame and chest wall and they are happy. I do not think it is possible to do this and still get a nice or even safe result. Sufficient "pedicle" breast tissue must be preserved to support the blood supply to the nipple. I perform all "medial pedicles" on my breast reductions which preserves much of the tissue in the upper inner aspect of the breast and because it cones and shapes the breast. Sometimes, in young patients, this pedicle can even have the appearance of "implants" because of the nice round shape and forward projection. It also doesn't lead to "bottoming out" like inferior pedicles often do because they are on the bottom of the breast and gravity takes its effects there. Studies have also shown that patients that are having symptoms (i.e. neck, back, shoulder discomfort, rashes, exercise intolerance) will usually have their symptoms disappear with even a modest breast reduction. Therefore, it is really not a "weight" issue as the insurance companies often try to demand from plastic surgeons. There is a balance in any breast reduction in regards to shaping and size. As you try to remove more tissue to make the breasts too small, you often flatten the breast and can loose projection and shape. Sometime if the "skin flaps" are thinned too much there can be contour irregularities as well. Also as a young person of 29 likely has more glandular component to her breast rather than fatty which means that a modest breast reduction will most often give excellent shaping and uplift as well as several size decrease in the breasts which allow patients to feel better about themselves, find the clothes they want, and also feel better as far as symptoms. Hope this helps!