Puffy Areolas: Is There a Fix? (photo)

Your pouty or puffy nipples can be treated by a circumferential (Benelli) mastopexy.  The reduction of your areolar is necessary to correct the poutiness of your nipples.   The problem is that your breast tissue has herniated into your nipples due to weak retaining collagenous structures.  Reduction of the areolar size will allow tightening of your dermis, the area just below the skin, and this will correct your pouty nipples.  This is done using, among other things, undermining of the skin around your nipple and a permanent suture placed at the edge of your new, smaller areolar.  All of this will lift your breast to some extent. 

With reference to your question about implants and whether the poutiness will return, that is a difficult question and one that should be answered in a face to face consultation with a Board Certified Plastic Surgeon. 

Hello, thank you for your question. Your photos show pseudoherniation of breast tissue into the nipple areolar complex causing the puffy appearance. The most common reason for this happening is tuberous breast deformity, however your breasts do not appear to be tuberous, you may just have weak retaining ligaments in the areola that allows tissue to push forward.Can anything be done for this? Yes, a periareolar or donut mastopexy would allow the surgeon to release the areola from the surrounding breast tissue and resize and flatten it. The scar would be around the nipple. Problems with these types of lifts is that the scars tend to widen and there is potential that the edges would look irregular and that over time your areola will look bigger and bigger, which means another procedure down the road. Also, because we're working around the nipple, there is potential that you may lose sensation in the nipple or be unable to breast feed. If these are important to you, then you may want to wait. Implants should not make the issue worse in the long term... in the immediate postop period they may stick out more due to swelling and pressure from the implant on the breast tissue but then should sette down.Make sure to consult w board-certified plastic surgeons, I hope this helps. - Dr. Leong

The puffy appearance of your areolas is very normal.  Many woman have areolas that appear just like yours.  The breast tissue herniates to varying degrees through the areola.  I would say that your breasts have an attractive appearance overall.  If the size/shape of your areolas bothers you a lot, you could have an areola reduction performed with a purse-string suture around the reduced areola that also flattens it.  The downside of this procedure would be a scar around the areola, which does heal very well in many women, but it is still a scar that could take away from the natural appearance of your breasts.  If you were to get breast implants in the future, they would not substantially change the appearance of your nipples.  I would recommend an
in-person consultation with a plastic surgeon in your area to allow for a thorough
physical examination and to make more specific recommendations.
Ziyad Hammoudeh, MD

What you are describing and have shown in the pictures is all within normal limits. Your arrolas are not like that all the time : when it is cold etc the skin muscle contract and make the areola smaller and less protruding. Although there is surgery that can be performed , you are essentially trading what you have for a scar . 

Another option would be to have a periareolar mastopexy which is a variant of the Benelli procedure...it involves less undermining of the surrounding skin and works very well for your anatomy and issues...keep in mind that if you have breast augmentation at a later date, you will need to redo the mastopexy if you want to keep the scar along the areolar border...two options would be to do the breast augmentation at the time of the mastopexy through the same scar, or to use a separate incision at a later date.