Gynecomastia surgery will obviously address the amount of tissue in the chest via gland removal. One of the remaining two issues to address, if needed, are the areola and the excess skin
We commonly refer to this as the nipple, although the nipple is the central protruding aspect, and the areola is the rest of the non-skin area. Sometimes the borders are very discrete, and other times there is a blended fading into the surrounding skin. Either way, if the areola is very enlarged or very malpositioned, some options to address these can help the overall results
Option one: superior areolar crescent lift. This is an easy and popular option to lift up the nipple by a centimeter to two centimeters during the case. It involves cutting a small ellipse of skin at the same time as the gland removal by placing the incision above the areola. By removing the skin, we can reposition the nipple a bit upward without changing the surgery much. The scar at the top of the nipple typically heals very well, but it is more visible there than it would be if we kept it below the nipple.
Option 2: circumareolar lift and reduction: sometimes the areola is so enlarged that It would simply look ridiculously out of place if not actively reduced. Passive reduction will occur in all cases as the skin and areola retract once the volume is reduced, but passive reduction is not enough in all cases. By actively reduced, I mean cutting a donut shape of areolar skin and closing it as a smaller circle. By converting the circle to an ellipse, we can also use this technique to lift up the nipple as well and even resect/reduce the excess skin
Option 3: always the most drastic, a double incision approach can manipulate the nipple in dramatic ways via reducing or lifting. But this option is used only in more advanced cases due to the scars it leaves.
In conclusion, at the time of your consultation, we will need to address any concerns you may have regarding the areola. If I see anything obvious, I will be certainly the one to bring it up, however in borderline cases (borderline enlargement, borderline malposition), I encourage patients to freely express their concerns/desires so that we can try to reach their ideal look.