3 years post op , what could be causing red and white bumps around scar? (

From your photo and description the white areas you mentioned may be scar tissue from the previous piercing. The red bumps could be areas of hypertrophic scar formation or perhaps suture material under the skin. Follow up with your surgeon or dermatologist for further evaluation.

The red spots around the edge of the areolae are in a pattern of underlying suture placement during the surgery. The sutures are usually absorbable and are typically gone at this point since it's been years. It's possible that there is chronic inflammation or just hypervascularity of where the sutures were. It's also possible that there is walled off suture material in those zones. These type of findings are not life threatening or serious issues but can be annoying. If it's just hypervascular tissue then a treatment with an laser / IPL may help diminish the redness. If it's retained suture material, it could be excised. It's always best to follow-up with your surgeon to go over the options or seek out a consultation in-person to undergo a physical exam and a better determination of the best options for you. As for white bumps at old piercing sites, my guess is that it's where scar tissue has filled in the old holes. I hope this helps.

You probably have some hypertrophic, not keloid, scarring which can be treated with steroid injections. Please go back to your surgeon.

The white spots most likely represent scar tissue since mature scar tissue, on fair skin people eventually turns white.
The red spots look like inflammation, perhaps mild acne.
At this point, you can probably follow up with your primary care doctor, or see a dermatologist.
Best,
Mats Hagstrom, MD