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

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!

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!