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HISTORY: This is a 33-year-old resident of Santa Rosa, California who presents to the Novato office in Marin County, California for evaluation of his gynecomastia. He has a severe Tanner III to Tanner IV gynecomastia. He complains of having very large pendulous breast that have gotten worse over the years. He weighs approximately 230 pounds and his chest has become quite large. He presents with adolescent gynecomastia. He never takes off his shirt due to the severity and embarrassment of his chest. His goal is to be able to wear a t-shirt. He underwent gland excision and suction assisted lipectomy with liposuction of the axilla. We extracted 400 cc from each chest and about 600 cc from the axilla or armpit. His surgery was performed at Marin Cosmetic Surgery Center in Marin County, California. He had 108 grams of tissue removed from his right side and 97 grams of breast tissue removed from his left. His photographs were taken 4 months after surgery.