Am I right in thinking breasts should be too high and square in the beginning for a nice outcome?

Dear CrinkleBear,Thank you for your question. After a breast lift or breast reduction, results tend to "settle" and shift as the body heals. To what degree this occurs depends on many factors, including differences in each individual's body, skin and tissue quality, how extensive the procedure was and very importantly: the technique your surgeon used. I tend to advise my patients that, the way they look the day after surgery is not how they will look 3 months after. The breasts will be higher on the chest wall initially, before the breasts and nipple positions settle into place. 
In the end, each patient's results will be unique to their body. To get an accurate idea of what kind of results to expect, make sure you consult with a board-certified plastic surgeon thoroughly before proceeding with a breast lift or reduction. Hope this helps!

Hi and welcome to our forum!
The performance of breast reduction is an insult to the soft tissues of the breast, resulting in significant swelling which will initially distort and totally mask the result. The swelling may pull on the incisions, responsible for the initial "boxy" look at the inferior poles. The amount of swelling differs from individual to individual. 60-80% of the swelling abates in the first 6 weeks, with the remainder slowly subsiding over 6-12 months. One cannot determine the final result until the swelling subsides. Persistence of a boxy look may require revisional surgery at one year. 15% of cosmetic procedures require a secondary touchup. 
Although the surgeon is responsible for the operative result, the quality of the skin and soft tissues may play a role for any recurrent sag or unnatural look after the procedure. 
Visit a board certified plastic surgeon with considerable breast reduction experience for in-person evaluation and discussion. . Look at the before and after pictures.
Best wishes...

The technique I recommend is 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.  The breasts can look very high and unnaturally full at first but they do drop and reshape to some degree.  However, I do not prefer them to descend very much.  Best Wishes,Gary Horndeski, M.D.

Dear CrinkleBear,
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

Hello,I haven’t found this statement to be true in my clinic with patients. Everybody heals differently which includes how much they experience swelling and muscle tightness immediately following surgery.

In order to achieve the best results, you should seek a reputable surgeon and ensure you have done research and seen before and after photos to allow you to make a more informed decision. 

Yes, generally speaking,I think you are correct: breasts tend to soften and "settle" to some degree over the course of the first several months after breast reduction surgery. Exactly how much the breasts will change however will differ depending on many factors. One of these factors includes exactly what procedure is performed and the skill level (and sense of artistry) of your plastic surgeon.My best advice: select your plastic surgeon very carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as well.   I find that the use of goal photographs and computer imaging are very helpful during this communication phase. Working together you will come up with a good plan to achieve your goals.   
Best wishes.