I’m a 19 y/o female with puffy areolas I also have somewhat inverted and small nipples, what are my options? (Photos)

It appears that mayor contribution would be enlargement of the nipples; that alone may visually diminish puffiness of the areolas? One of the techniques available for correction of inverted nipples should solve the problem. If you would like to address puffy areolas it may require an additional scar along areola/skin border. In person evaluation is recommended. Good luck.

The inverted nipples can be treated with an easy in office procedure under local anesthesia.  Many of the  milk ducts can be preserved, in case you should change your mind on child bearing in the future. The puffiness to the areolas is quite normal.  In order to flatten the areolas out, a scar around the areola would be needed and I do not believe that it would improve the appearance of your breasts.  

Inverted nipples can cause functional and body image problems for women. An inverted nipple can look flat or a slit like depression or hole at the normal nipple location. There are different degrees of inverted nipples possible.  Usually correction of the inverted nipples involve division  of the lactiferous (milk ducts). Risks of the procedure include potential loss of sensation, inability to breast-feed, recurrence of the inversion and the potential need for further surgery.  


 In my practice, if a patient's inverted nipple everts spontaneously or with manipulation, I generally do not advise surgical correction at the time of breast augmentation surgery; these patients often experience the eversion of the nipples with breast augmentation surgery alone. On the other, if a patient's nipples are permanently inverted, regardless of temperature change or stimulation, then I will correct the inversion at the time of breast augmentation surgery.  This decision-making (and advice) boils down to careful consideration of pros/cons  and possible risks/complications.


 
 My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with.   Your plastic surgeon, based on your history and physical examination, will be your best resource for accurate assessment and advice.


 Best wishes.