These steps illustrate how a breast reduction is done:
The lines indicate the area of skin, breast tissue, and fat to be removed and the new position for the nipple.
Skin above the nipple is brought down to reshape the breast. Stitches close the incisions, giving the breast it's new contour.
Scars around the areola, below it, and in the crease under the breast are permanent. They can fortunately be concealed easily by clothing.