Cosmetic surgeons work at minimizing the appearance of scars and you are considering gynecomastia surgery where the incision is in the arm pits as you believe that might hide the evidence of surgery. Entering the skin from the arm pit still creates a scar and due to the distance between the arm pit and the glandular tissue that is to be removed, a larger incision may be required than if the nipple-areola complex (NAC) approach was used. Even if the arm pit approach is used, in order to achieve the best result for you, your surgeon may still need to enter the peri-areola area to adequately remove glandular tissue and create smooth contours. Keep in mind that the gland takes up space under the nipple-areola complex and that its' removal creates a depression that often needs to be leveled by advancing surrounding fat. My preference is to use a hemi-lunar areolar incision that is placed on the pigmented area near the border. This nipple-areola complex (NAC) approach allows direct access to the glandular tissue that is to be removed and to the fat that is brought together in the center to level the area. Additionally, the areola incision gives the best view and access to the entire surgical area and therefore helps in ensuring that the site is free of any bleeding before closing the skin. Very fine stitches are used to close the skin and In my experience these heal up very well and patients are consistently happy with the results. Put differently, while the arm pit access may be an option that some surgeons will offer you, much more commonly the NAC access is used. Sometimes gynecomastia may be made up of mostly fat in which case liposuction alone can create an excellent result. If only liposuction is required then incisions are not necessary but rather tiny entry points can be made with a biopsy punch.

Richard Buckley