A Practical Way for Nipple-Areola Complex Reshaping in Circumareolar Reduction of Gynecomastia.

Gynecomastia correction is the most common breast surgery in males.[1] Surgical reduction is indicated in Grade IIB and Grade III gynecomastia in Simon's classification.[2] A circumareolar incision may chosen according to skin and areolar excess. Achieving a symmetrical nipple-areola complex is one of the major goals of the reduction surgery. The average areola diameter of males is measured as 2.67–2.8 cm in anatomical studies.[3,4] Using the parts of 50 cc syringes as templates is appropriate for measuring the areola, since a plumber tip of a standard 50 cc syringe has a diameter of 2.85 cm, which is consistent with the male areola (Figure 1). The opening of the syringe barrel can be used for marking the circumareolar incision, like a cookie cutter, when used for a female areola. The surgeon's assistant gently presses the breast mound with both hands and the areola is compressed for 5 seconds with the opening of the barrel while the nipple is at the center. The resulting ring-shaped groove can then be used as an outline of the 2.85 cm diameter areola around the nipple. The outer part of the areola is deepithelialized concentrically or eccentrically as needed. After glandular tissue excision, intradermal circumareolar purse string sutures are placed and tightened around the plumber tip of the syringe. The plumber tip ensures a symmetrical shape and diameter of the resulting areola (Figure 2). This method has been used in five patients in the last six months. The diameter of the areola held by purse string sutures widens to a certain degree with time. Using this inexpensive (approximately $0.40), already sterilized, and easy-to-find material as a template is a logical option. We would like to share this technique with our colleagues.

Figure 1.

Parts of a syringe used as templates. Opening of the barrel is used for marking the periareolar incision. Plumber tip is used for adjusting circumareolar purse string sutures.

Figure 2.

(A) This 38-year-old man presented with Grade III gynecomastia. (B) Photograph obtained 6 months postoperatively.

Disclosures

The authors declare no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.