No extra cost! It's part of the lift. We actually use some thing called a "cookie cutter" real name is areolar marker to ensure circular cuts on the native areola and on the breast skin we then bring it through.
deflated in Raleigh Ah! There are different size 'cookie cutters'. I judge by a ratio of areola to breast. Smaller breasts get smaller areolas. If you like larger ones, just something to mention to your surgeon!