A 31 year old man requested plastic surgery to help him with gynecomastia. The examination of the breasts, revealed a combination of soft breast tissue peripherally and more rubbery and firm breast tissue below the areola. The total gynecomastia was small to moderate. I recommended a combination procedure with liposuction of the breasts and direct excision of the firmer tissue tissue via a areola incision. The liposuction yielded 275 cc total of fat removed, including 150 cc from the larger right breast and 125 cc from the smaller left breast. The before and after photos are taken 1 year after surgery.