Natural Saggy C Cup Breast Tissue "Removal" Prior to D Size Implants? Possible?

What you are proposing is not done commonly, unless one does a subcutaneous mastectomy for high cancer risk. The sagging breast tissue is not the problem, but the stretched out inelastic skin. If your nipple is at the level of your breast crease, you have pseudo ptosis, which can be improved to a certain degree with an augmentation only. Without the benefit of photos, I would suggest a vertical breast lift first followed by an augmentation. An alternative to an implant would be fat augmentation of your breasts. I often see significant improvement in the skin quality from this procedure.

You are essentially speaking of a subcutaneous mastectomy with implant reconstruciton. This is a technique used in patients at high risk for breast cancer but not commonly used in the typical breast enlargement/lift case.