In many situations, liposuction is a great procedure to offer patients that have gynecomastia. The best candidates for liposuction are those that have primarily a fatty component to the chest, a good nipple position, and reasonably good skin quality. If a patient has excess, loose skin, or sagging in the chest, they are probably better off with an alternative technique that requires a skin excision or nipple repositioning procedure. Patients with a more glandular component and no loose skin might be better off with a direct excision of glandular tissue through a periareolar approach in conjunction with liposuction. In \\u201cborderline\\u201d patients where there is some glandular tissue and moderate loose skin, I often will do liposuction first to see how the tissues respond. This minimizes incisions and often gives a good result that patients are happy with, and avoids large chest incisions. If a second stage is needed to perform a glandular excision or a skin excision in these borderline cases, then they can be done three to four months after the first procedure.