This gentleman has had a gynaecomastia reduction. He has shaved his chest preop and the postop images are taken at 3 months when his chest hairs have grown back. He had significant breast volume with excess skin and in this scenario direct excision is the best method of removing the excess tissue and giving a flat appearance. In this scenario the nipple areola complex has been removed and grafted into a new position and in essence a mastectomy has been performed of the breast tissue. Results of this operation can be dramatic and patients tolerate the resultant scars very well. The pros and cons of this type of operation need to be discussed with a surgeon with experience in all the various techniques of gynaecomastia surgery.