Depends on the dress. Mine was fairly simple (chose that for EXACTLY this reason) and didn't have any intricate beading. They were able to take it from an 18W to a 10...it required a very talented seamstress (among other things, the boned bodice had to be completely taken apart, reshaped, re-assembled with the newly formed boning, etc).
Find someone good in your area who specializes in wedding dresses, call, and ask them - they will be better able to assess your particular dress and how it can be altered without damaging the look.
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