Can I fix the puffiness of my nipples without getting breast implants? (photos)

Protrusion (herniation) of areolas is frequently seen in tuberous and other forms of narrow base brests; if that is the only issue that you wont to correct, there are some procedures to improve that "deformity", This is usually done in local anesthesia or as a part of breast augmentation. Hope this helps. Good luck.

Dear miambrose,
tuberous breasts are not simply small or underdeveloped breasts. The appearance of the breast can range from mild to severe, and typical traits include: enlarged, puffy areola, rather wide spacing between the breasts, very little breast tissue, sagging, higher than normal inferior breast fold, and narrow base at the chest wall.The type of surgery best for you will depend on the severity of your condition.My preferred technique for tuberous breast correction involves a multistep procedure where the breast tissue is released in a radial pattern to prevent herniation into the areola and placement of a custom implant size is in the breast to allow appropriate expansion of the breast in the restricted dimensions. This can often be done in a single procedure but sometimes may require two surgeries.That said, it is best that you visit a board-certified plastic surgeon for an in person examination. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

A periareolar mini mastopexy (scar only around the areola) may help reshape the puffy areola and possibly part of the flat area just below the areolas. This would not affect the size.
While I realize you do not appreciate the present shape, they are perfectly fine just the way they are.