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It looks like what is called a herniated nipple/areolar complex. Without an in person exam it is difficult to tell, but it looks like there may be some constriction of the lower pole. This can be corrected with surgery which releases the constriction of breast tissue that pushes the areola out. Some manipulation and repositioning of the breast tissue may be done, and the areola can be reduced in size. Once the constriction is released, an implant, if desired may give a rounder contour. An implant alone or a procedure removing just some areolar tissue doesn't work unless the puffiness is very small and without constriction.
It appears that you have puffy areolas/nipples, no underlying tuberous breasts. This can be corrected with a simple procedure in local anesthesia. You should look for a plastic surgeon familiar with this correction. Good luck.
There does appear to be some construction of tissue around your nipples. If you’re concerned about their appearance, the tissue can be surgically released to give you a rounder shape.
It doesn’t appear that there is any constriction of tissue around your nipples, which is the trademark of tuberous breasts. If there is, it is mild. For this reason a straightforward breast agumetnaiton may be sufficient.
You don’t appear to have any constriction of tissue around your nipples and you have a defined breast fold. For these reasons, your breasts are probably not tuberous. Areola reduction and a lift may be sufficient in achieving your goals.
