Can I improve volume/appearance without increasing cup size? My current cup size is D. (Photos)

Tootsie23,
I concur with your surgeon. I do not think that you are a "D". Frequently clients who have more laxity or droop to their breast will choose a bra that is larger than their true breast volume to handle the extra skin and to keep the nipples under bra cover. I suspect that this may very well be your case. Without the luxury of a full examination, it appears a breast lift with implants would optimize your results. When the implant is placed your overall volume and fullness will be greater, but I suspect you will wear the same bra size. You will just look better in it.
If in doubt I would not hesitate to obtain another opinion, but it sounds to me like your surgeon is giving you sound advice.
Best of luck

I can understand how this sounds confusing! Let me try to help clarify. What takes up room in your bra cup is both breast tissue and skin. Based on the photos, the amount of breast tissue present is small, while the amount of skin present is relatively high. You may be filling a D cup currently, but it is more excess skin than breast tissue making up most of the volume in that cup. The surgeon saying you do not have a D cup was likely referring to the amount of breast tissue you have, not the combined volume of breast tissue and skin. Once the excess skin is removed, the breasts will sit higher and perkier, but they will not fill a D cup. When a full lift is done, even when you don't remove any breast tissue, the total volume (breast + skin) goes down because of all of the excess skin that is removed. To maintain a D cup bra, or the same total volume you are accustomed to, you would need to also add an implant. In doing so your cup size would not increase unless you put large implants in.

Hello,Rather than argue about cups, which are irrelevant, discussing the salient issues would be more constructive. You will need a formal mastopexy to adequately address glandular sagging and expanded areolas effectively, with little risk of excessive scaring and re-expansion of the areolas, as seen with circumareolar lifts. As you might imagine, this is a reductive surgery so your breasts will not be bigger. To fully optimize shape, I suggest a tall, flat, highly cohesive and shaped breast implant; this too will likely not change your breast size significantly, leaving you will similar proportions that you have now. Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery and are experienced with shaped devices. Best of luck!

Thanks for your question.I think that you will get your desired result and wont be bigger but will have a beautiful and full breast after a proper lift.  By removing excess skin and replacing it with some volume with a small (250 cc ) implant you will have a nice and full chest without the sag.

Dear Tootsie23,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
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for your photos. Cup sizes vary across brands but it seems that you are a D in most bra sizes. Initially it doesn't seem like you would be a D because you have deflation of your breasts and significant sagging or ptosis. This gives the illusion of a smaller breast,  however it makes sense that if you were to fit your breast skin and tissue into a cup, it could very well fit a D or larger cup. The reason your plastic surgeon is anticipating not affecting your cup size is because he may not remove much breast TISSUE, but he will remove quite a bit of skin to tighten up your breast envelope and bring your nipples back into the correct position. I would still expect a 250cc implant to slightly increase your fit into your current bra however you may still fit within a D range since skin will be removed. You may always decide to just do a lift only, without implants. This will lift the breast and tissue,  however you will likely have a flat slope to your breast similar to what you have now unless you add an implant which gives that added structure necessary for superior pole fullness of the breast. Hope this helps!Johnson C. Lee, MDBoard-Certified Plastic Surgeon@drjohnsonlee

Your breasts have overhang (ptosis) and upper pole deflation. This results in your breast curvature filling out the lower part of the cup of a D bra, but most likely, your upper pole is somewhat empty. Additionally, unlifted ptotic breasts have loose skin which allows repositioning your native breast tissue in a bra in order to shift it into better cleavage. When a surgical breast lift is performed, the excess skin is removed and the envelope of skin is tightened. This has the effect of reducing projection and making the breast look 1/2 to 1 cup smaller in many patients (studies have been done looking at this and have confirmed this approximate effect). The addition of a modest sized implant can restore the projection while also giving you more upper pole fullness and a rounder, more aesthetic shape when combined with the lift, so it is possible to get a perkier, more voluptuous bust without necessary upsizing the total projection much. Surgical simulation software like Crisalix can be helpful in visualizing potential changes and educating patients.

Hi and thanks for your questions and photos. After reviewing your photos it seems that that you would be a good candidate to have a breast lift using the Bellesoma technique.  Many patients similar to yourself achieve a fantastic result with just a lift using the Bellesoma technique - no implant required.    
Bellesoma is a new breast  lift technique that seems like it would be a great fit for you.  This procedure utilizes 3-D volumetric scanning and a multi-point measuring system to design a precise surgical blueprint exactly tailored to your body and the lifted perky breast that you desire. The Bellesoma procedure reduces the sagging and weight of your breast, lifts your breast and reduces areola diameter, preserves the nipple sensation and ability to breast feed, and looks as full and perky as if an implant had been placed without using any implant, so no need to compromise.  One of the huge positives of this technique is that there is no vertical incision traveling down the front of your breasts.  If more volume is desired, a natural fat transfer can be performed after the lift.
Some of the differences between Bellesoma and the traditional breast lift techniques:
-Bellesoma creates upper pole fullness that traditionally needed an implant to achieve.
-There is NO vertical scar, only well-hidden scars in the fold under the breast, and around the areola.
-The breast is dynamically supported by attaching it to the muscle, so there is no recurrence of sagging which are expected with traditional lifts or reductions.
-The entire central portion of the breast is undisturbed, so nipple sensation remains intact and is very unlikely to be compromised.
-For absolute best results, patients should have a stable weight and have a BMI under 30.
The procedure is accomplished by using the skin of the lower pole of the breast (the part below the nipple that sits in the bra cup) to shape the whole breast into a perky dome, then straps are made of the extra skin, anchoring it to the underlying chest muscle so that there is virtually no chance of repeat sagging.  The skin that above your nipple and below your collar bone is utilized to cover the perky, lifted dome that has been created and then a new (usually smaller) circular opening for the areola is placed at the high point of the cone, creating your new lifted, full and shapely breast.
From your description or your desired result and photo, you seem to be a very good candidate for this new technique and should really get the look that you are desiring without implants or unnecessary visible scars. I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons in your area or an area that you would like to travel to on holiday who offers the Bellesoma technique to discuss your breast lift and possible results.
Best wishes!

Thank you for your question and photos.  The short answer is yes, you can.  Since you have excess skin that is what is filling up your bra cup to a size D.  Your true breast volume is not a size D.  So if you do a lift (which I would recommend) and put in a small implant you should be able to maintain the cup size D, yet have fuller and more perkier breasts.  Make sure you see a breast surgeon who performs a lot of breast lifts. 

Bra sizes can be very confusing. That being said, even though you wear a size D bra, you likely do not fill the upper portions of the cups. I see a lot of patients just like yourself who wear D bras, but do not seem to have a lot of breast tissue. Based on the photos you provided, you need a breast lift and a small implant to give you more upper pole fullness. The general rule is that a lift reduces you by about a cup size and each 150-175cc of breast implant increases you by about one cup size. So if you have a lift and a 250cc implant you will be around a D/DD but should now fill out the top portion of the cup! I hope this helps!Best,~Dr. Sieber