Breast reduction from 32D/30DD - how small can I go? Discomfort and an athletic career

You have a complex situation.  Right now you want much smaller breasts.  You need to establish a few goals: size, shape and the amount of scarring you will accept.  Most women want them to be smaller but maintain a good shape, preferably with the least amount of scarring. You may be into mountaineering now but that may change.  In your case you have full breasts with minimal sagging.  You still want to have good shape with minimal scarring.  My advice would be two options; 1. Specialized liposuction by itself to reduce the size.  2. Reduction with a vertical type scar- around the areola and down the middle.   I would only do the second if you were okay with the scar and you really really wanted to be as small as possible.  I recommend having specialized liposuction alone performed. It is always best not to look like you have had surgery. In both cases about a 1/4 breast size reduction.Your situation is difficult because you are in great shape. Your breasts have great shape but are too large for your body.  The 32 and a large cup size make it difficult for clothing etc. Traditional breast reductions work best in women who have large and sagging breasts.  You only have the large and no sagging (minimal....)

Thank you for the question.
Yes, it is possible to reduce the breasts size very significantly. 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.  
With the goal of improving communication with my patients (determining their goals in regards to breast size after breast reduction surgery) 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” etc. 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.
I hope this, and the attached link, helps.