The surgery you're observing is a nipple areolar reduction (nipple lift surgery). This is for a young patient who has larger, widened areolar tissues, and wants a smaller areolar size (periareolar mastopexy). In order to do this, we remove the excess areolar skin and then elevate the breast skin in a circumferential manner around the areola so it's loosened. Then I use a suture called a GORE-TEX Suture that is extremely strong and versatile and does not stretch. I use this in a "cartwheel-style" pattern and cinch it in to reduce the size of the areola. The entire breast tissue will come in and you will get a really nice, small areolar diameter.