This is a 26-year- old male from San Francisco, California, who presents with adolescent gynecomastia. He lost weight from 240 down to 175. Due to the laxity of his skin and the poor quality of his skin he was given the option of the one stage free nipple or mastectomy keeping the nipple attached to a pedicle. He underwent mastectomy which is excision of skin and relocation of the nipple. His scars are healing well, and the photographs are seen approximately four months after surgery. He had 352 grams of tissue including skin removed on his right side and 398 grams removed from his left side. His surgery was performed at Marin Cosmetic Surgery Center in Novato, California.