Gynecomastia can be defined as breast tissue found in a male. In general gynecomastia can be categorized with the "Tanner "stage or levels. A mild form of gynecomastia presents with a small amount of fat usually found distributed throughout the chest wall, however no significant amount of glandular tissue behind the nipple areolar complex. The most severe stage of gynecomastia is associated with thick glandular gynecomastic tissue retroareolar [ behind the nipple} as well as skin laxity. The etiology of gynecomastia can include steroid abuse, medications, thyroid disease, adrenal carcinomas, testicular cancers, hypogonadism, renal and liver diseases and marijuana use. Gynecomastia can normally be detected clinically by examination by a Board Certified Plastic Surgeon. The tissue behind the areola is often very thick and hard and cannot be suctioned out through liposuction. For mild gynecomastia , liposuction of the chest wall is successful but with more severe cases a small incision under the areola and a partial subcutaneous mastectomy [direct removal of thick tissue} leads to a better result, smoother chest wall and a flatter appearance.