Having a large areola without excess fat and/or breast tissue is not considered gynecomastia. Areola reduction can be performed and it will reduce the size of the pigmented skin. The peri-areolar incision is used, the same incision as for stage two gynecomastia surgery, for the man that has extremely large male breasts, in order to remove excess skin. The incision is then closed with purse string sutures. If the nipple is enlarged, a nipple reduction can be performed as well.
Before male breast reduction surgery
After male breast reduction surgery
The cosmetic plastic surgery goals for male breast reduction are very different than for a woman. The man with gynecomastia desires an almost flat chest, leaving just enough fat and breast tissue to have a natural looking contoured chest. This needs to be achieved without visible scars so the man is comfortable going shirtless.
The woman wants to decrease volume and lift the breast into an aesthetically pleasing shape. In most cases this requires repositioning the nipple. For the woman there will be scars but they do tend to fade with time.
Before breast reduction surgery
After breast reduction surgery