Why My Liposuction + Glandular Pull-Through Technique Is Superior to Traditional Resection
Posted March 24, 2026 in Gynecomastia Surgery
Gynecomastia surgery has evolved. Or at least it should have.
For decades, the standard approach to male breast reduction involved a half-moon incision placed along the lower border of the areola. The surgeon would directly excise the glandular tissue from underneath the nipple. That method still exists. Many surgeons still use it.
I do not.
After performing thousands of aesthetic procedures and refining my approach to male chest contouring, I developed a combined technique that produces a more natural, athletic result with less visible scarring and a lower risk of deformity.
4 Min. Read:
The Problem With the Traditional “Half-Moon” Incision
Historically, gynecomastia was treated with a periareolar incision under the areola to remove glandular tissue directly.
The issue is that the chest is not just a gland.
Two common problems arise with this traditional approach:
1. Visible Scarring
Even when well-healed, a scar along the lower border of the areola can remain noticeable. For many men, this becomes a telltale sign of surgery.
2. Saucer Deformity
When too much tissue is removed directly beneath the nipple without proper contouring of the surrounding chest, a central depression can form. The nipple appears caved in. This is known as a saucer deformity.
It is unsightly and often difficult to correct, sometimes requiring fat grafting or revision surgery.
The goal is not simply removal. It is sculpting.
My Combined Technique: Liposuction + Glandular Pull-Through
Instead of cutting directly under the areola, I make a small incision in the lateral chest crease. This incision is discreet and typically very difficult to detect once healed.
Step 1: Full Chest Liposuction Contouring
I perform liposuction across the entire chest, not just behind the areola. This allows me to sculpt the pectoral borders, blend into the lateral chest wall, contour toward the axilla, and create a smooth athletic transition.
This step also mobilizes and breaks up the glandular tissue.
Step 2: Glandular Pull-Through Removal
Using a specialized instrument, I remove the glandular tissue through the same small lateral incision. There is no need for a visible periareolar scar.
Because the chest has already been contoured with liposuction, I preserve proper tissue thickness beneath the areola. This significantly reduces the risk of saucer deformity.
The result is a smooth, flat, masculine chest.
The Added Advantage of Renuvion® (J-Plasma®) for Skin Tightening
In men with mild to moderate loose skin, gland and fat removal alone may not be sufficient. Skin quality is critical to the final result.
Renuvion®, also known as J-Plasma®, uses helium plasma energy combined with radio frequency to create controlled subdermal heating. This produces immediate contraction and continued tightening over several months.
Benefits of gynecomastia surgery include:
- Enhanced skin contraction for a tighter chest contour
- Improved adherence of the skin to the sculpted pectoral muscle
- Sharper definition along the pectoral borders
An additional benefit is areola contraction.
A widened areola can feminize the chest. Traditionally, the reducing areola size required a circular periareolar excision, which leaves a circumferential scar.
With Renuvion®, we can often achieve internal tightening that promotes areolar contraction without creating a visible circular scar. This results in a more proportionate, masculine-appearing areola without additional external incisions.
For the appropriate candidate, this elevates the result significantly.
Why This Approach Produces Superior Results
There are many reasons why my combined approach delivers the outcome patients are dreaming of before undergoing the procedure:
- Minimal visible scarring
- Reduced risk of saucer deformity
- Full chest sculpting rather than isolated gland removal
- Skin tightening without large excisional scars
- Faster, smoother recovery
Most patients describe recovery as tightness or soreness rather than significant pain, and return to exercise relatively quickly.
Frequently Asked Questions About Gynecomastia Surgery
What is the best technique for gynecomastia surgery?
The most effective approach removes glandular tissue, contours the chest with liposuction, and addresses skin laxity when necessary. A combined liposuction, glandular pull-through, and selective use of Renuvion® often provides superior contour with minimal visible scarring.
Can loose skin improve without skin removal surgery?
In men with mild to moderate laxity, Renuvion® can significantly improve skin contraction without large external scars. Severe skin excess may still require excisional procedures.
Will my areolas look smaller after surgery?
If areola widening is related to skin laxity, internal tightening with Renuvion® can promote contraction and improve masculine proportions without a circumferential scar.
Schedule Your Gynecomastia Surgery Consultation in Miami, FL Today
It’s important to choose a surgeon qualified to perform your gynecomastia surgery, such as board-certified plastic surgeon Dr. Daniel Careaga. This will ensure your procedure is done safely and that you get the results you desire. If you’re ready to take the next step and learn more about gynecomastia surgery, call Careaga Plastic Surgery at (305) 960-7511 or fill out our online contact form to schedule a consultation.