Gynaecomastia is a dual component problem, due to an excess of both breast gland and fat, a combined approach is necessary in order to achieve the flat chest. With the fatty component liposuction is used, and most patients will require, an additional surgical incision during the reconstructive breast surgery, usually around the nipples to deal with the other component of the problem, the excess gland which is situated just beneath the nipples. In some cases where patients have undergone large weight fluctuations or reductions, such patients also experience dropping of the skin in addition to the fullness of the chest, therefore some form of skin removal and tightening will also be required.