I'm 3 weeks post periareola mastopexy. I have one spread nipple and the other is very tight. What can be done? (Photo)

Hopefully you had been able to discuss both the details of your procedure in consultation with your surgeon, including various options of size and shape. Some patients will have a
better shape to their breast such as increased superior fullness if an implant
is used at the time of mastopexy. The procedure can also be combined with a
minor breast reduction to reduce the breast width if desired. The surgery will
create an elevated, more youthful breast contour. Also, the procedure will
create nipple and areolae of the desired size and at the correct height.There are plenty of risks from any surgical procedure, and here the #Hypertrophic or #keloid scars can be a problem. The worst are usually under the breast with
an #AnchorLift or inverted “T”. These
can be treated like all thickened scars with re-excision, laser, kenalog/5-FU
injections, creams, silicone strips and other methods to reduce and improve
healing. Now, since you have already been healing for three weeks, it is your option to contact your surgeon with concerns about your scars, and whether or not they are helming properly. You have the ability to treat them with creams but your doctor should help. Good luck!

Periareolar breast lifts are done by some surgeons but they are not a favored procedures because of the very problems that you are having:  the areolar may stretch larger again, the stitches may become exposed through the skin, the front of the breast flattens as the stitches are tightened.  Converting this type of breast lift to a Wise pattern lift may take tension off of the areola and minimize it's spreading.  This can be done with dissolving sutures so suture exposure won't be a problem.  If permanent stitches become exposed, you will need to have them removed and this removes the sitich which keeps the areola small, so it may spread.  Return to your surgeon and express your concerns.

Thank you for your question and photosFrom your pictures it appears that the purse string which is used to maintain the size of the areola has given way. As a result the areola spreads as the tension relaxes. The puckering you see on the opposite breast is common early on and is due to the tightness being maintained by a continuous running suture. The bluish color is a common permanent suture which is used to stent the areola. The sutures you may feel are often absorbable and can be removed if poking through the skin. Once the areola has spread it will not go back to a smaller diameter like the opposite breast. At this point there are a few options. One consideration is to release the other breast which will relax and result in an areola of similar size. The other is to replace the suture which has failed resulting in smaller areola which matches the opposite breast. Finally you could revise the lift and use an anchor type pattern also known as a Wise pattern. This is an effective lift but does have more scarringBest of LuckDrG 

it is likely that the purse string suture on the left sde broke-see your surgeon for removal. The purpose of the suture is to prevent spreading of the areola thus the right side with the intact suture may not spread as much.