What can I say to help surgeon understand how important perkiness & smaller areolas are to me?

I would recommend that you have an additional consultation with your plastic surgeon and you should bring in photographs of people who have the areolar size you are seeking and the perkiness you are seeking to see if your surgeon believes you can achieve this. You should be aware that placing the nipple areola complex too high can result in it showing out of the top of your bathing suit, and this is extremely difficult to correct. Best wishes.

Dear Ejsss,
you should discuss all your concerns with your surgeon prior to surgery and make sure that he/she understands your goals and wishes. My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

You can show some wish pics to your surgeon to illustrate your goal, as well as re-state exactly what you said here in your question. However, please note that while your surgeon will do what they can to achieve your expectations, there may be limits on how high your nipple placement can be depending on several factors, such as your body and surgical technique.

Hello @Ejsss, Thank you for your question. When discussing your goals, why you would like to have surgery, you should be clear in communicating your desired results. Depending on the specialist surgical technique that is used for breast lift and repositioning mammary tissue and nipple, there may be different approaches to achieving what you are looking for. For example, in breast lifts, I always perform this surgery with the BraLift technique, which allows me to give a really adequate aesthetic result. Best wishes! Alan Gonzalez MD. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Hi Ejsss,
You have one opportunity to make your goals known, and that is before surgery...the moment you go to sleep, your surgeon asked to act in your best interest, guided by what you have told him or her. I would suggest scheduling another appointment, to explicitly make her goals known and make sure that you are on the same page.
I hope this helps.
Christopher Pannucci, MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

It is important that you communicate openly with your surgeon and that you are comfortable and confident with your surgical plan as you prepare for surgery. I encourage you to visit with your surgeon again to discuss your surgical goals. Bring photos that have a look that is similar to what you are wanting. Be sure to keep in mind that your anatomy is unique and that surgeons are not able to simply duplicate a look. So it is vital that you and your surgeon both understand what is desired and what results can realistically be expected.

Find a photo of a lady whose breasts you like and show that to your surgeon. Remember, everyone has different anatomy and your surgeon must work with yours. To have really perky breasts that maintain their perkiness, you need smaller breasts. Large breasts will not stay perky. Nipples, however, should not be placed too high since you will have difficulties finding bras and bathing suits that will cover them well, and your breasts will look like they sit too low. The bases of your breasts cannot be moved. Those with low sitting breasts will never have high perky breasts.

When we do a lift, we intentionally "shove" tissue up behind and above the Nipple complex. When you wake up, you may have a bit of a fog light appearance rather than a headlight appearance. over the next 4 months the tissue falls behind the Nipple and the shape changes to a headlight configuration. If you desire an exaggerated or "skylight" appearance, you should be aware that wardrobe issues and visible areolas in some tops may occur. Definitely talk to the doctors office ahead of the scheduled surgery date/time.