is there any possibility of going from a sagging D to an A (perky or not doesn't really matter)? (photo)

You need a formal evaluation by a licensed plastic surgeon and expert in breast reductions to determine what is best for you and your goals.Breast reduction is one of my favorite surgeries as it allows me to dramatically improve a woman’s breast appearance as well as alleviate many physical symptoms of large breasts, such as back, neck and shoulder pain, bra strap grooving, and rashes under the breasts. When I perform breast reduction surgery, I generally use a superomedial pedicle to provide blood supply to the nipple while maintaining fullness in the upper and inner breast. Excess lower and outer breast tissue are removed. Breasts are often asymmetrical, so I remove more tissue from the larger breast. The final scar pattern is a circle around the areola, down the breast, and possibly under the breast, depending on the degree of skin excess.
For me, breast reduction is not a one-size-fits-all surgery. The size and shape of the breasts are customized to each patient depending on her goals and desires. Some women want a significant amount of tissue removed while others prefer to have a more limited reduction. Regardless of the amount of tissue removal, I perform the maximum safe amount of lifting and tightening for each patient.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Reductions. - Dr. Cohen

Thanks for your question! The cup size is partially dictated by the width of your breast. While you may not be able to go into an A cup, I think a full B cup is a reasonable expectation. With any breast reduction, you are also getting the benefit of a lift, so I would consider it an added bonus for you. Good luck!

The best way to determine what your breast size should be with respect to your anatomy and give true advice would be an in-person exam with a board certified plastic surgeon who performs hundreds of breast procedures annually. Not only does proportion depend upon the aesthetic balance of your breasts with your shoulders, waist, hips, and buttocks, but also upon your objectives, active lifestyle, soft tissue quality, muscular anatomy, and long-term concerns. There is also a limit to how small you can go due to tissue that needs to be retained for the nipple/areola to maintain a good blood and sensory nerve supply.
The surgery will also help to reshape and recontour your breasts. Very large breasts have the natural tendency to sag or hang low, so breast reduction surgery will lift them up and help them look perkier under tight clothing. The gram amount is dependent upon the density of the breast tissue and the volume removed. No direct correlation exists with cup sizes. You and your board certified PS can determine whether your goal "size" is realistic.

The technique I recommend is a lift using The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.Best Wishes,Gary Horndeski, M.D.

Hi. Based on your photo, you should be able to get a really nice result from a breast reduction. A breast reduction both reduces the size of the breast, as well as lifts and reshapes the breast.  It is important to convey your goals clearly to your surgeon.  I would recommend consulting with a board-certified plastic surgeon good experience in this area. Good luck and take care, Dr. Howell.

It's very difficult to predict postoperative bra size because both the size and shape of the breasts change after surgery so it's very difficult to tell what bra size will feel right for you.  Also, we can't fit the bra on during surgery :(.  From your photos it appears there is definitely a lot of skin that can be removed which will markedly improve the sagginess.    

Dear Glorious5692,
Breast reduction is best suited for women who wish to decrease the size of their breasts. While there are different techniques used to perform this surgery, I prefer the vertical incision (lollipop pattern) breast reduction technique instead of the anchor scar pattern, which reduces more noticeable scarring than usual. I also use a SAFE liposuction technique to reduce additional fat around the stubborn axilla area and bra line. This way, my patients are achieving beautiful results with minimal incisions which reduces downtime and delivers an overall better breast shape long term.If you are considering breast reduction surgery, you should consult with a board certified plastic surgeon to discuss your options and make sure your surgeon understands your goals. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hi and welcome to our forum!
From your photographs, the distance from the top of your breast bone to the nipple iappears increased. The distance from the nipple to the bottom of the breast is relatively normal. You demonstrate moderate sag.
Breast reduction is both cosmetic and functional, as the procedure often alleviates neck pain, shoulder pain, back pain, bra strap grooving, and chronic rashes beneath the breasts due to their added weight. In minimal-moderate reductions, the nipple areola is maintained in a "stalk" (pedicle) of breast tissue to provide blood flow. 
The breasts can be reduced to any size, but the reduction is most often performed to regain proper body proportion. Don't go too small.
Without examination, I cannot determine if there is enough tissue present to achieve insurance coverage, but from a surgical standpoint, you should obtain an excellent result as the reduction also includes a lift which will elevate your nipple-areolar complexes into normal position and restore the conical shape of the breasts.
Seek an in-person consultation with a board certified plastic surgeon for evaluation and discussion.
Best wishes...

Hi and thank you so much for your question. I would suggest meeting with a Board Certified Plastic Surgeon and discussing your goals for your breasts. I have not examined you, but you look like a great candidate. I would be open with your plastic surgeon regarding size, and also take into account the smallest size you could be with preserving blood flow to the nipple, as safety of the surgery always comes first. Thank you so much for the great question and all the best.Sincerely,Dr. Rachel Streu

Based on the photo, you would benefit from a breast reduction surgery. This procedure will reduce and reshape the breasts to give you a more proportional, fuller breasts and may not need a lift to improve the upper pole. The best course of action would be to schedule an appointment with a board-certified plastic surgeon for an in-person examination and a detailed discussion of your surgical options.