Scars and hollowing after gynaecomastia: how they evolve and the crater deformity

Two very different things get lumped together when the result of gynaecomastia surgery is discussed. One is the scar: a line at the lower edge of the areola that camouflages well but takes far longer than people imagine to flatten and fade. The other is the contour: whether the chest has been left smooth or whether a depression has been left in the middle. And that second one is not a healing problem but a question of how much tissue was removed.

They are worth separating because they are prevented differently, treated differently and judged at different moments.

This page sets out the medium-term result from the general guide to gynaecomastia. What is removed and what is kept in theatre is explained in gland, liposuction or a combined technique.

Where the scar goes and why there

In the usual plan, the glandular excision is done through an incision at the lower edge of the areola, following the line where the dark skin of the areola meets the skin of the chest. To that are added, where there is liposuction, two very small access points —the size of a cannula— in the inframammary fold and at the side.

The choice of that edge is not accidental:

• It is a natural boundary of colour. A line on a change of tone is noticed far less than the same line in the middle of a uniform surface.
• It gives direct access to the tissue that has to be removed, which is right underneath.
• It is an area under little tension, which helps the scar not to widen.

The systematic reviews of this technique —liposuction-assisted surgery with a minimal periareolar incision— confirm that the small-incision design is a sound technical approach, with consistent improvement in quality of life, although they warn that the methodological quality of most published studies is low.

Three different scars, and what decides which one is yours

There is not one single gynaecomastia scar. There are three, and the difference between them is not a preference of whoever operates: it is how much skin is left over.

The usual one is the lower hemiareolar: a semicircle running along the lower half of the edge of the areola, right where the skin already changes colour. It is the route described by Webster in 1946 and it remains the one used in most cases, because through it the glandular disc can be removed and the surrounding fat treated, and because its course coincides with a boundary that already existed. A few months on it is hard to find even when you know where it is.

The full periareolar goes round the whole circumference. It is considered when, besides removing contents, the size of the areola has to be reduced or it has to be moved slightly, something that comes up when the chest has had volume for years. The scar is longer, but it is still hidden in the same place: the boundary between the two skin colours.

The mastectomy one is another matter. It does not pass through the areola: it sits at the lower edge of the pectoral muscle and runs across the chest from the midline to the outer edge, because its aim is no longer to reach the glandular tissue but to remove the excess skin.

And there is something else worth knowing beforehand, because it changes a good deal of what one expects: by this route the areola is moved as a free graft. It is detached completely, reduced in size if need be and fixed in the anatomical position that belongs to it on the now flat pectoral, which need not be the one it was in: when the chest has descended, the areola has come down with it, and putting it back where it belongs is part of the operation. That has consequences the other two routes do not have. Sensation in the nipple is lost or substantially reduced, and it is not expected to return. The graft may change colour compared with the original tone, lighten in patches or, less often, take only partly. And to the two scars —the pectoral line and the outline of the graft— has to be added stricter aftercare during the first few weeks, while the graft takes its nourishment from the bed.

That is not a reason to rule it out: in the cases where it is indicated, the alternative —leaving skin that no longer fits untreated— gives a worse result. But it is the reason this route is held in reserve and not proposed lightly, and why it is worth having it discussed beforehand and not afterwards. It comes up when the problem is no longer what is inside but the wrapping: after a substantial weight loss, or in the advanced grades, skin is left over, and skin that is left over is not resolved by removing more contents. It is the most visible of the three, and that is why it is not proposed for surgical convenience but when the alternative —leaving the skin untreated— would give a worse contour than the scar itself.

That relationship between grade and skin is exactly what orders Simon’s classic classification, which separates cases by volume and by the associated excess of skin. That is why the answer to “what scar am I going to have?” comes out of the examination and not out of a table, and why it is as well to be wary of anyone who promises it over the phone.

When a case is borderline there is a prudent decision worth knowing about: starting with the short incision and assessing the result some months later. The skin retracts on its own more than most people expect, and it is not unusual for what looked as though it would need a long scar to end up not needing one. Adding a skin resection afterwards is possible; removing a scar that is already there is not.

How long it really takes to mature

Here it is worth being exact, because it is the wrong expectation that causes the suffering.

A scar goes through phases: first it is pink or reddish and slightly raised, then it gradually flattens and loses colour, and finally it is left as a pale line. On the chest that process is especially slow. The surgical literature on male torso contouring points it out explicitly: the maturation of chest scars is long, and they take years to flatten and fade.

Translated into what matters:

• At a few weeks, the scar is at its worst to look at. It is normal and it is temporary.
• At a few months, it starts to flatten and lose the reddish tone.
• At a year or more, it approaches its final appearance, and it can go on improving after that.

Judging the result at two months makes no sense. Neither for good nor for ill.

What helps and what does not

What it does make sense to do:

• Protect it from the sun while the scar is active. It is the measure with the most real impact: a young scar exposed to the sun pigments and that pigmentation can take a very long time to go, or never go. Physical cover or high-factor sun protection.
• Do not strain the area in the first few weeks. Tension on a scar in formation is what widens it, and on the chest the tension comes from the pectoral.
• Follow the care instructions the team gives at the check-ups, which are adjusted to how each person is progressing.

What is best not expected:

• That it will disappear. A scar fades a great deal; it is not erased. Anyone promising otherwise is promising something that cannot be delivered.
• That it will progress the same in everybody. The individual tendency to scar —including a predisposition to keloids— counts, and it is something assessed before surgery.

The crater-like hollow: what it is and why it happens

It is the contour complication most specific to this surgery, and it has nothing to do with the scar.

It happens when too much tissue is removed just beneath the nipple-areola complex. Without that support, the areola is left stuck to the deep plane and sinks relative to the chest around it, forming a depression in the middle. The effect is paradoxical: a bulge was corrected and a hollow appears.

That is why, in theatre, a thin layer of gland is deliberately kept under the areola — the technical detail explained on the page about the operation.

That this is not theoretical is shown by a comparative study from 2025 on 32 breasts: in the group treated with glandular excision, four cases of crater deformity appeared, while in the group treated with liposuction alone the problem was the opposite —“puffy nipples” and a higher reoperation rate for tissue not removed. It is a small series, but it illustrates the balance well: on one side you fall short and on the other you go too far, and the surgeon’s job is the point in between.

Contour irregularities, which are another matter

They get confused with the crater and they are not the same. Here there is no central depression, but a surface that has not been left even: areas slightly fuller or emptier, or an abrupt transition between the area treated and the rest of the chest.

They are usually due to uneven liposuction or to an insufficient transition with the surrounding tissue. In a cohort of 145 young patients they were described in 9.2% of the breasts, the second commonest problem after residual tissue.

Most of them settle during the first few months, as the swelling goes down and the tissue rearranges itself. Those that persist are assessed at a check-up.

What can be done if the contour has not turned out well

First of all, waiting the right length of time: the result is not judged before the swelling has gone completely and the tissue has settled, and that means months. Many irregularities that worry people at three months are no longer there at eight.

When something persists after that time:

• Mild irregularities can improve with a touch-up liposuction or with a fat graft to fill the defect.
• An established crater-like hollow is more demanding: the correction involves restoring volume under the areola, and it is revision surgery that has to be approached with realistic expectations.
• A widened or hypertrophic scar has its own range of treatments, chosen according to its state and how long it has been there.

The published reoperation rates vary a great deal between series —a systematic review of 18 studies puts them between 0.6% and 25%, with only 2 pieces of work of good quality—, which says less about the real risk than about how disparate the literature in this field is. In the ten-year series we use as a reference, surgical revision was 4.8%.

Frequently asked questions

Does the gynaecomastia scar show much?

It goes at the lower edge of the areola, where the skin changes colour, which is where it camouflages best. At a few weeks it is at its worst —pink and slightly raised—; after that it flattens and fades gradually, a process that on the chest is especially slow.

How long does it take to disappear?

It does not disappear: it fades. On the chest, the literature describes maturation that takes years to flatten and fade completely. What should be expected is a continuous improvement over all that time.

What is a crater deformity?

A depression in the middle of the chest that appears when too much tissue has been removed under the areola, leaving it without support. It is not a healing problem, and that is why it is prevented in theatre by keeping a thin layer of gland.

I have a hollow where I had surgery — can it be fixed?

It has to be looked at, and first enough time has to pass so as not to judge tissue that is still swollen. An established hollow is corrected by restoring volume in the area, and it is revision surgery approached with realistic expectations and with an explanation of what can and cannot be done.

Can I sunbathe?

Once the wound is closed you can get on with normal life, but the scar must not be exposed to direct sun while it is active: it pigments easily and that pigmentation can take a very long time to go. Physical cover or high-factor sun protection.

And if I have a tendency to keloids?

It is an important fact to mention before surgery, not afterwards. It affects the assessment and the scar care measures, and it forms part of what is discussed at the first consultation.

My chest has been left uneven — is that normal?

In the first few months, yes, it is common and it usually improves as the swelling goes down. Contour irregularities that persist are described in around 9% of the breasts operated on and are assessed at a check-up.

Sources

• Hurwitz DJ. Boomerang pattern correction of gynecomastia. Plast Reconstr Surg. 2015;135(2):433-436. PMID 25626790 — 24 consecutive patients; it states expressly that the maturation of chest scars is prolonged and that they take years to flatten and fade.
• Ali SS, Ahmed I, Khurram MF, Rehman N, Abhishek R. Gynecomastia Surgery: Liposuction Alone versus Liposuction with Endoscope-Assisted Glandular Excision—A Comparative Study. Indian J Plast Surg. 2025;58(4):269-275. PMID 40894818 — 32 breasts: four cases of crater deformity in the glandular excision group, against puffy nipples and a higher reoperation rate in the liposuction-alone group.
• McNamara CT, Nuzzi LC, Firriolo JM, et al. Complications and Quality of Life following Gynecomastia Correction in Adolescents and Young Men. Plast Reconstr Surg. 2022;149(6):1062e-1070e. PMID 35349529 — 145 patients: contour irregularities in 9.2% of the breasts, the second commonest problem after residual tissue (12.6%).
• Prasetyono TOH, Budhipramono AG, Andromeda I. Liposuction Assisted Gynecomastia Surgery With Minimal Periareolar Incision: a Systematic Review. Aesthetic Plast Surg. 2022;46(1):123-131. PMID 34379157 — review of 18 studies on the minimal periareolar incision: a sound technical approach with consistent improvement in quality of life, reoperation rates between 0.6% and 25% and only 2 pieces of work of good methodological quality.
• Li CC, Fu JP, Chang SC, Chen TM, Chen SG. Surgical treatment of gynecomastia: complications and outcomes. Ann Plast Surg. 2012;69(5):510-515. PMID 21712702 — a ten-year series: an overall surgical revision rate of 4.8%.
• Webster JP. Mastectomy for Gynecomastia Through a Semicircular Intra-areolar Incision. Ann Surg. 1946;124(3):557-575. PMID 17858862 — the original description of the semicircular incision at the edge of the areola, which remains the usual approach.
• Simon BE, Hoffman S, Kahn S. Classification and surgical correction of gynecomastia. Plast Reconstr Surg. 1973;51(1):48-52. PMID 4687568 — the classification into grades that orders cases by volume and by the associated excess of skin, which is what determines the extent of the scar.

Sources checked one by one against PubMed on 12 August 2026.

Book your consultation

If you have had surgery and are not happy with how the scar or the contour has turned out, the first thing is to know where you are in the process: many things that worry people at three months are no longer there at eight. At the Instituto de Cirugía Plástica del Mediterráneo, in Valencia, we also assess the results of operations carried out at other centres.

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Educational content reviewed by Dr Alessandro Thione, registration no. 46/4621959, and Dr Alberto Ruiz Cases, registration no. 46/4624050, specialists in Plastic, Aesthetic and Reconstructive Surgery. The progress of a scar and the correction of a contour defect require assessment in person; this information does not replace a medical consultation.

Dr Alessandro Thione

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4621959

Dr Alberto Ruiz Cases

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624050

Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.