Dr. Rivera-Serrano uses two types of approaches. The first one is for patients with small chests, in whom solely liposuction and removal of the glandular tissue via a small, well-hidden incision beneath the areola is sufficient. The second group of patients are the ones with a clear excess of skin, where removal of skin is mandatory for an adequate result and often need something called free nipple grafting. This means that the nipples and areolas are completely detached and then inset as a graft (patch). Due to the skin removal, patients will have longer and more visible scars along the inferior aspect of the chest, which can be quite prominent initially but tend to mature and look better over time. There are many patients that fall in the grey zone between both categories. Sometimes, the first approach is tried in these patients, and then the skin is left to contract and re-drape. If the result is satisfactory after about six months, no more is done. However, if excess skin is still present, a second skin excisional procedure may be carried out. A personal consultation will determine what is best for you.