Why Men Should Avoid the Old-Fashioned Areolar Incision for Gynecomastia Surgery

Posted March 25, 2026 in Gynecomastia Surgery

Gynecomastia surgery has changed dramatically over the last 20 years. Unfortunately, many surgeons still use an outdated technique that involves making a half-moon incision along the lower border of the areola to remove the gland directly.

On the surface, it sounds easy: Remove the gland and flatten the chest. But the male chest is not that simple. When gynecomastia surgery focuses only on removing tissue rather than sculpting the chest, the results can look unnatural and sometimes even worse than the original chest.

Understanding how the gland is removed during gynecomastia surgery is one of the most important things a patient should ask about during consultation.

4 Min. Read:

Table of Contents

• The Problem With the Traditional Areolar Incision Technique
• What Is a Saucer Deformity After Gynecomastia Surgery?
• A Question I Hear From Almost Every Patient
• My Technique: Liposuction + Glandular Pull-Through
• J-Plasma® Skin Tightening for Gynecomastia
• The Goal of Modern Gynecomastia Surgery

The Problem With the Traditional Areolar Incision Technique

The classic gynecomastia technique involves a semicircular incision along the lower edge of the nipple (areola). Through that incision, the surgeon cuts out the glandular tissue located behind the nipple.

This approach dates back to a time when liposuction technology was limited. Today, we know this technique has several important drawbacks. First, it can leave a visible scar along the areola, but the bigger issue is what happens beneath the skin.

Because the gland is removed directly through the nipple incision, surgeons often remove tissue from directly under the nipple itself. When too much tissue is removed from that location, the nipple loses the support that keeps it projected forward.

The result can be a complication called a saucer deformity.

What Is a Saucer Deformity After Gynecomastia Surgery?

A saucer deformity is one of the most common complications seen after traditional gynecomastia surgery. It occurs when too much tissue is removed from beneath the nipple during gland excision.

Instead of a smooth, masculine chest contour, the nipple collapses inward and creates a sunken, crater-like depression under the areola. The surrounding chest may still have fullness, making the indentation even more obvious. This creates an unnatural appearance that can be difficult to correct.

Revision surgery for saucer deformity often requires:

• Fat grafting
  • Tissue grafts
  • Biologic mesh
  • Complex reconstructive surgery

Even with advanced techniques, restoring a completely natural chest contour can be challenging. In other words, the best treatment for saucer deformity is preventing it in the first place.

A Question I Hear From Almost Every Patient

One of the most common questions I hear during gynecomastia consultations is: “Do you remove the entire gland?” Patients are understandably concerned that if the gland is not removed completely, the gynecomastia could come back.

The answer is yes, the gland should be removed. However, the way the gland is removed matters tremendously. With the traditional areolar incision technique, surgeons usually remove the gland from directly behind the nipple because that is the easiest location to access through the incision.

Unfortunately, that is exactly what creates the risk of a saucer deformity.

My Technique: Liposuction + Glandular Pull-Through

In my practice, gynecomastia surgery is performed using a modern minimally invasive technique that combines:

• Full chest liposuction
• Glandular pull-through removal
• J-Plasma® skin tightening

Instead of focusing only on the tissue behind the nipple, the entire chest is treated as a sculpting procedure.

First, liposuction is performed across the entire chest. Most men with gynecomastia have a combination of fat and glandular tissue, not just glandular tissue. Liposuction allows the chest to be contoured and blended naturally into the surrounding anatomy.

Once the chest is sculpted, the gland is removed using a pull-through technique through very small hidden access points. This allows the gland to be freed from the surrounding tissue and removed from underneath and around the nipple, rather than carving it out directly from the center. By leaving a thin layer of supportive tissue beneath the nipple, the areola’s natural projection is preserved.

This technique allows complete gland removal without creating a saucer deformity.

J-Plasma® Skin Tightening for Gynecomastia

After the fat and gland are removed, the skin must be tightened to match the new chest contour. This is where J-Plasma® (Renuvion®) skin tightening becomes extremely useful.

J-Plasma® combines radio frequency energy with helium plasma to tighten the underside of the skin and stimulate collagen contraction. This helps the skin retract smoothly against the chest wall, allowing excellent tightening without large incisions or skin removal.

The Goal of Modern Gynecomastia Surgery

The goal of gynecomastia surgery is not simply removing tissue; it is creating a natural, masculine chest contour that does not look operated on.

Older techniques that rely on the half-moon areolar incision focus primarily on removing tissue behind the nipple. Unfortunately, this can create the very deformity patients are trying to avoid.

By combining liposuction, glandular pull-through removal, and J-Plasma® skin tightening, it is possible to remove the gland completely while preserving the natural structure of the nipple and chest. The result is a flatter, more athletic chest with minimal scars and a much lower risk of complications like saucer deformity.

Gynecomastia Surgery in Miami

If you are considering gynecomastia surgery in Miami, choosing the right technique and an experienced board-certified plastic surgeon is essential. Modern minimally invasive approaches allow men to achieve natural results with faster recovery, minimal scarring, and a chest that simply looks the way it always should have.

The best gynecomastia surgery is the one no one can tell you had.

Schedule your consultation at Careaga Plastic Surgery today by calling (305) 960-7511 or filling out our online contact form.