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

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.