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This 48-year-old man is 6’ and 235lbs. He has had gynecomastia since adolescence and prior to surgery would never expose his bare chest in public. He underwent glandular excision of the chest, supplemented with axillary liposuction. The possible need for a secondary lift was discussed during consultation. The left side requires a peri-areola lift for skin excision and elevation of the nipple areola complex.