If the diameter of the areola is not too wide, spare areolar tissue is removed by incising the bottom part of the nipple, gathering the tissue in this area and then suturing the area below the nipple. After surgery, the area that was incised may look wrinkled, but it spreads out over time. The scar would be located right under the nipple making it difficult to notice.
If the diameter of the areola is very wide, spare tissue is removed by incising around the boundary of the areola. This method is commonly selected when performed in conjunction with breast reconstruction or breast reduction.