The reduction of the nipple-areolar complex during Gynecomastia Surgery presents some challenges.
During Gynecomastia Surgery, the tissues beneath the skin and areola are removed (the breast tissue, that is)
Extra Manipulation of the areola during that surgery has to be done expertly to maintain blood supply and avoid necrosis. Even in expert hands, there is increased risk to the areola and nipple complex as compared to simple periareolar approaches. Nonetheless, I find that it is best to adress the size of the nipple to avoid funny looking results, despite the increased complexity of the surgery.
This is an example of a very enlarged areola. removing the gland tissue without adressing the size of the areola would result in a flat chest, and some natural areola shrinkage, however a large areola would remain.
to adress this concern, the circumareolar surgery is indicated. There are incisions at the outside border of the original areola as well as incisions around the areolar skin that is to be preserved (in men, I try to leave about 3 cm of diameter for the areola)
Here is what the results look like as well as the location of the final scar:
