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.