Why is the periareolar keyhole method not used on larger chested men? (Photo)

The purse string suture is one of the better methods for the closure of cutaneous, rounded surgical wounds in the surgical world. The typical male areola is around 2.8 inches in diameter, so the excess of the areola is usually cut away and sutured. My question is can the diameter of excised skin be increased to beyond the excess areola in order for larger chested men to have the optimal amount of breast tissue removed without having excess skin and the need for double incision surgery?

Doctor Answers 9

Peri-areolar technique for gynecomastia

This technique can work for the right patient. There can't be too much excess skin or their may be rippling of the skin around the new areola. I would see aboard certified plastic surgeon to see if this an appropriate technique for you to give you the results you desire.

Bethesda Plastic Surgeon
5.0 out of 5 stars 49 reviews

Why is the periareolar keyhole method not used on larger chested men?

It's been my experience that avoiding circular incisions for skin reduction produces the most aesthetically pleasing result. The NAC tends to contract naturally. The more important aspects of the procedure are complete excision of the gland and lipo of the surrounding tissues.

Ron Hazani, MD, FACS
Beverly Hills General Surgeon
4.9 out of 5 stars 293 reviews

Skin excision with gynecomastia treatment

In the vast majority of gynecomastia patients skin excision is simply not needed. There is an inherent capacity of the skin to retract even in those men who have more advanced gynecomastia in terms of size.

Any skin removal pattern can be used. The reason why we don't use various patterns familiar with female breast reduction is because they are designed to narrow and shape the breast. This is not something men are interested in--they want it flat and manly.

The periareolar approach is not a powerful technique at all as it won't remove much skin and certainly won't elevate the nipple much. It can leave a "pizza" scar around your areola which can look terrible and is difficult to treat. This approach is abused because doctors convince patients that it saves them from larger scars and patients like how that sounds.

Robert Caridi, MD
Austin Plastic Surgeon
5.0 out of 5 stars 17 reviews

Periareolar Skin Reduction for Gynecomastia

Hi... The periareolar skin reduction approach can work but only in select patients.  There is a limit (relatively small one) to how much skin can be reduced using this technique.  Also, there is a limit (relatively small) to how much "lift" this technique can reliably provide.  Finally, there is the issue of blood supply that must be considered if other work is being done, like removing gland tissue.  In the end, this is a valuable technique but in a limited subset of patients.  Good luck.
Dr. Parham Ganchi - NJ Plastic Surgeon

Parham Ganchi, PhD, MD
Wayne Plastic Surgeon
4.8 out of 5 stars 160 reviews

Periareolar keyhole method for male breast surgery

The true periareolar approach is not a good choice for most patients whom need skin envelope reduction. It inevitably results in widened areola diameter over time regardless of steps to prevent it. All but the most minor needs for a lift or reduction will do better by adding a vertical skin excision as it dramatically offloads the tension vectors you produce.

Robert Oliver Jr., MD
Birmingham Plastic Surgeon
5.0 out of 5 stars 3 reviews

The purse string suture is one of the worse methods for gynecomastia repair,

The purse string suture is one of the worse methods for the closure of cutaneous, rounded surgical wounds in the surgical world.you should read my book about gynecomastia,and you will learn that there are other ways to approach it without taking a risk of bad scarring  

Mordcai Blau, MD
New York Plastic Surgeon
4.6 out of 5 stars 76 reviews


The incision used really depends upon many factors including skin laxity, volume of gland, volume of fat, to name a few. Each procedure is individualized for the patient's anatomy. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews


The answer would be a definite maybe. It is possible to do this operation on larger chests. Sometimes there is just so much skin that you know it won't work. I usually purse-string the areola and tolerate some gathering. The gathering will slowly improve. If after a year you still have issues, scar revision can be considered. There can also be issues with viability of the nipple in larger chests.

Tracy E. McCall, MD
Milwaukee Plastic Surgeon
5.0 out of 5 stars 1 review

Gyno surgery

Thank you for the question but without photos or an examination it is hard to say what operation would give you the best result.

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 62 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.