Gynecomastia refers to male breast enlargement resulting in a feminine chest contour. The tissue composition of the enlarged breast is biologically comprised of fat and mammary gland.  Glandular gynecomastia most often appears as an oval subareolar mass attached to the nipple. The excess breast tissue is firm, inelastic, and does not respond to liposuction. Direct excision techniques are necessary when planning glandular gynecomastia surgery. Anabolic steroid use and innate hormone sensitivity are thought to be potential causes of glandular gynecomastia.  Fatty gynecomastia is principally composed of excess fat. Its causes are more diverse. Hormonal sensitivity, obesity, steroids, and medications all may trigger this condition. The excess fat is diffusely spread throughout the breast and chest. With fatty gynecomastia, the breast is soft, compressible, and blends indistinctly with adjacent normal tissue. Liposuction is especially effective in the treatment of fatty gynecomastia.  Most patients presenting with gynecomastia have an excess of fat and gland. Optimal gynecomastia treatment outcomes are usually achieved with a combination of liposuction to aspirate fat and direct surgical excision to remove the gland.