38I to a D at least? (Photos)

You appear to be an ideal candidate for a breast reduction and your desire to be reduced down to around "D" cup size is quite reasonable. Without an examination it is difficult to determine approximately how much tissue would need to be removed in order to obtain this relative outcome. It is possible that removing more than what your insurance company requires for coverage will still allow you to obtain the "D" cup size that you want.You should schedule some additional consultations with reputable board certified plastic surgeons and see if the above can be accomplished for you.Good luck!Steven Turkeltaub, MD

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery; this operation tends to be one of the most patient pleasing operations we perform.
 
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. There is simply too much variability among bra cup manufactures to make it a useful metric when it comes to preoperative communication and/or post operative predictions.
 Before undergoing the breast reduction procedure it will be very important to communicate your size goals with your surgeon (who you should choose very carefully). Most patients wish to achieve 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. For example, I have found that the use of words such as “proportionate” or “D or DD cup” 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. 
Once you have communicated your goals carefully, your plastic surgeon will be able to provide you with an estimation of how much tissue will need to be removed, in order to achieve your desired outcome.
Best wishes with your breast reduction procedure; hopefully you will be very pleased with the outcome of the procedure performed.