Having a large areola without excess fat and/or breast tissue is not considered gynecomastia. Areola reduction can be performed and it will reduce the size of the pigmented skin. The peri-areolar incision is used, the same incision as for stage two gynecomastia surgery, for the man that has extremely large male breasts, in order to remove excess skin. The incision is then closed with purse string sutures. If the nipple is enlarged, a nipple reduction can be performed as well.