My goal is to go from an A to D cup, I have tuberous breasts and inverted nipples -- is this possible? (Photos)

 Thank you for the question. 
 Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. Although difficult to ascertain without in-person consultation, I do not think achieving a "D cup" is unrealistic.
There are several steps taken to select a specific size/profile breast implant for a specific patient. These steps will vary from one practice to another.  I prefer to have a wide selection of implants (all profiles) available in the operating room. I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 
Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
 I hope this helps. Best wishes for an outcome that you will be very pleased with. 

Thank you for sharing your photos. Yes, I would agree that you fall on the spectrum of tuberous breast deformity. The increase in size will depend on the amount of skin available and the quality of your skin--it's ability to stretch and accomodate an implant. The tuberous breast deformity must be overcome by repositioning your lower breast fold, lifting your nipples, and scoring the breast tissue to allow it to stretch before putting in an implant. This is often done in the same surgery--breast augmentation with a mastopexy (breast lift). I would recommend focusing more on achieving your goal to overcome the breast deformity and improve your symmetry rather than trying to get to one particular size. Good luck on your journey!

Thanks,
Dr. Howland

Thanks for your question.  Since there is no way to say definitively over the internet which size would be optimal for you, take comfort in the fact that the surgeon uses your unique measurements and is able to provide you with a general range.  In many cases the board certified plastic surgeon can best be your guide as they’ve met with you in person and heard your aesthetic goals. You may consider doing 3-D imaging; however with nearly all the breast cases we’ve performed, we’ve found patients enjoy doing a live “try on” session where they actually can “try on” the implant in a non-padded bra in our office.  This does not give an exact measurement of outcome, rather it gives a nice idea of what to expect. For patients who desire a more natural look we like to recommend the shaped implant.  For patients who desire a more full, voluptuous look we recommend a higher profile implant (like Inspira). Remember that all breasts have at least some amount of asymmetry (we like to say they’re like sisters and not twins).  An in-person consult is the best way to discuss your questions.   Be sure to find a surgeon with the following credentials:  *Board Certified by the American Board of Plastic Surgery -- The gold star symbol   *A member of the ASPS (American Society of Plastic Surgeons) -- The circle symbol  *A member of the ASAPS (American Society of Aesthetic Plastic Surgeons) -- the Queen Nefertitti symbol with a Triangle.  My best, Brian Coan, MD, FACS