Is It Possible to Get a B Cup from 40DD After Breast Reduction?

This amount of reduction is substantial, but can be accomplished with a breast reduction.  The areola might need to be grafted for safety which would render it anesthetic, but the operation can be done.

Thank you for the question.

Unfortunately, there is no direct correlation between the amount of tissue removed and the ultimate cup size that a patient will wear after breast reduction surgery.

Before undergoing the breast reduction procedure it is very important to communicate your size goals with your surgeon.  Most patients, like you, wish to achieve a enough of a reduction to help with their symptoms while remaining proportionate with the remainder of their torso. 

With the goal of improving communication with my patients I find the use of photographs of “goal” pictures (and breasts that are too big or too small)  very helpful. I have found that the use of words such as “natural” or “B cup” or "very small looking" means different things to different people and therefore prove unhelpful. 
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

It is possible to reduce the breasts size very significantly.   Sometimes  when patients want “almost nothing left”  the reduction should be done in 2 stages.  The concern with the amount of tissue removed is related to blood flow to the remaining tissue;  if too much tissue is removed in one operation the blood flow to the remaining tissue (including nipple/areola)  may be compromised.   Part of the tissue that is left in place is called the “pedicle"; this segment of tissue is responsible for delivering the blood supply to the nipple/areola tissue. If the pedicle is made too small (in the effort to reduce the breasts as much as possible)  then patient will likely have problems with tissue survival.  Doing the procedure in more than one stage allows the tissues to  acclimate to the surgically decreased blood flow before  further tissue removal (and potentially further decreased blood flow)  occurs ( with the 2nd stage operation).

The other concern with overly aggressive breast reduction surgery is patient dissatisfaction  afterwards.  It is not unusual for patients who have lived with very large breasts to want to have as much as possible removed. Care must be taken to be judicious in this removal to avoid an outcome where the breasts  are too small in relation (proportionately) to the patient's other body parts.  Again, it is not uncommon, for patients'  breasts to become smaller ( after the breast reduction procedure) with time and/or weight loss-  breast augmentation may become necessary to achieve the patient size goals.
 
Best wishes.

While it is theoretically possible to reduce the size of the breasts dramatically, two sets of problems arise when you change their size to this extent. The first has to do with risks of poor healing, including loss of the blood supply to the nipple, or loss of sensation to the nipple. The second has to do with the final cosmetic appearance-- the more breast tissue is removed, the less the surgeon has to work with to create an aesthetically pleasing shape to the breasts.
In general, I have found that most patients are willing to accept a slightly larger cup size (perhaps a full C) if this means a better overall shape and look to the breasts with an operation that poses less risk of complications. Discuss these options with your surgeon in detail so that you can make the best informed decision.
Good luck!

Dr. Salemy