The technique of gynecomastia surgery that you will require depends on the degree of redundant breast fat, glandular tissue, and skin that you have. Patients with firm skin, minimal glandular tissue, and excess fat may require liposuction only. However, most patients do present with excess glandular tissue and thus will require a combination of liposuction as well as direct excision of the glandular tissue underlying the nipple and areola complex. Less often, patients with extensive redundant skin and sagging breasts may require direct excision of the breast skin, fat, and glandular tissue. In these patients, the nipple-areola complex must be replaced as a skin graft.