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This is a 31-year-old male with grade 4 severe gynecomastia who presents for free nipple mastectomy of his gynecomastia tissue and fat. Due to the laxity of his skin and the amount of tissue it was elected to do a one stage procedure instead of a two stage gyno male breast reduction surgery. He underwent free nipple mastectomy with removal of a large amount of tissue on both his right and left side. We extracted about 1600 cc of fat and aspirate in addition from the abdomen and he also had flank liposuction. His photographs are seen approximately six weeks after surgery.