A trans-areolar, nipple-skirting S-incision for gynaecomastia correction with preservation of blood and nerve supply to the nipple-areolar complex

Abstract Background Gynaecomastia is a common condition in men that can lead to significant psychological distress and physical discomfort. Surgical excision of breast tissue is indicated in persistent cases. Traditionally used peri-areolar incisions lead to noticeable scarring, and improved intra-areolar approaches do not explicitly account for blood and nerve supply to the nipple-areolar complex (NAC). We aimed to evaluate the trans-areolar, nipple-skirting S-incision as a novel surgical approach for the correction of mild to moderate gynaecomastia, focusing on neurovascular safety and aesthetic outcomes. Methods This pilot case series included sixteen patients with Simon’s grade 2 A and 2B gynecomastia who underwent repair using the trans-areolar S-incision at a tertiary academic hospital. Adjunctive liposuction was performed in most cases. Postoperative monitoring included clinical follow-up and assessment of patient satisfaction using a structured questionnaire. Results All patients completed follow-up assessment. Twelve patients (75%) reported being “very satisfied” and four (25%) “fairly satisfied” with their outcomes. Twelve cases (75%) were bilateral. The weight range of excised breast tissue was 10–160 g and the mean weight was 80 g per breast. There were no cases of NAC necrosis. Seven patients (44%) experienced transient sensory changes only. Complications included one seroma and one haematoma. Both were managed without long-term sequelae. Conclusions The trans-areolar, nipple-skirting S-incision offers an anatomically safe and aesthetically favourable approach for the surgical management of mild to moderate gynaecomastia. It explicitly preserves NAC vascularity and sensation, limits visible scarring, allows for good surgical access and is associated with high patient satisfaction. Evidence level Therapeutic Study, Level IV.