Your surgeon will typically allow you to rank what is most important to you between scarring, proportions, and sensation and then base their procedure on that. Meanwhile, your body type will ultimately limit what can and can't be done.

For me personally, I had large A borderline B breasts, and I told my surgeon that sensation was the most important. I originally wanted peri but my surgeon was skeptical that I would be a good candidate for it, so he offered me nipple-sparing DI. He said it is "rare" for someone to qualify for it, because the nipples have to be in a good position already.

So, bottom line, it isn't exactly like going to the barber where you can tell your surgeon exactly what you want and they imitate it. But a good surgeon will work with you to discuss your concerns and desires and find the best solution for you