HISTORY: This is a 16-year-old resident of Salida, California who presents to the San Francisco, California office for evaluation of his gynecomastia. He has had severe male breast enlargement for the past six years. He does not take off his shirt in public. He has tried to fit in socially but has been very afraid of rejection. His goal is to have a normal chest. He is 510, 240 pounds. He underwent gland excision and chest liposuction. He had removal of 200 cc of fat from each side and 159 grams of breast tissue removed from his right side and 104 grams of tissue removed from his left side. His surgery was performed at Marin Cosmetic Surgery Center in Marin County, California. His photographs were taken 2 months after surgery. It was discussed that a secondary procedure will be helpful to tighten up the skin. He was happy with the outcome.