Though I believe that anything is possible...

...I would have to say photoshopped.  It doesn't seem natural.  The left one looks like it was edited  

However, would it be possible to view them up close and personal?  I think it would really help me get to the bottom of this...

Evelyn / Tei, TER ID: 189062 had natural "carriage bolts" but has had surgery that augmented her size and reduced her nipples. Her bolts weren't quite as big as in your picture but the pointy protrusion was almost the same.

Possibly real but I can't say, either.

The photo made me think of Pinocchio