Thank you for the question. You should know that all reductions are performed with a breast lift. The procedure should leave a youthful breast, elevating the nipple on the breast mound, reducing the diameter of the areola, and shaping the breast so that it ends at the inframammary fold.There are three elements I consider when I discuss breast reduction and cup size. First is patient preference, as at the end of the day, plastic surgery really is a service industry, and most of us are motivated by the goal of improving the quality of our patient's lives. The second consideration is body proportion. With reduction, I am hoping to remove enough tissue to relieve symptoms, but not so much as to detract from a pretty, youthful, feminine form. I emphasize to patients that their chest wall has a defined height and width. It is desirable to remove breast that extends into the underarm. It is pleasing to increase fullness in the upper pole of the breast, and remove gland that descends over the inframammary fold. Once the proper breast height and width is achieved, the only way to make the breast smaller is to limit breast projection, which may not be desirable. A flat breast isn't often a pretty breast! The final consideration is blood supply. The dissection to remove tissue cannot be so aggressive as to compromise the blood supply to the nipple and areola, skin, or gland that remains. I think that there are few patients that can change from a D cup to an A cup with a safe operation and a breast that looks great on their body, but that can only be determined through a physical examination. I would recommend a formal consultation with a BC plastic surgeon experienced with reduction mammoplasty. Hope this is helpful. Good luck!
