You bring up a very important issue: what is the perfect gynecomastia result? Is it a flat chest? Is it a chest without any fat? With some fat? What is it that comprises the most dramatic, attractive chest for a male? The answer is that it depends on each patient's own body. In my practice, many of my gynecomastia patients have spent a great deal of time in the gym before coming in, as they have tried diet and exercise. But with the issue of gynecomastia, no amount of dieting and exercising produce the desired result. Taking out too much fat would leave a patient with unnatural contour issues, and taking out too little fat or breast tissue would leave you without the chiseled look you desire. In addition, I perform my surgery without making any incision on the nipple/areolar complex, so you do not need to sacrifice the embarrassment of gynecomastia for the embarrassment of a noticeable scar. The truth is, a perfect result can be achieved. The chest wall is comprised of your pectoralis major muscle, with some amount of subcutaneous fat under it. The breast is an appendage that hangs off the pectoralis major muscle, composed of breast gland and fat, the proportion of which varies with age. The younger one is, the more breast tissue there is. The older one gets, the more fatty tissue occupies the breast space. The reason an outstanding result can be achieved from a tiny incision (4mm) in the hair-bearing skin of your armpit is because specially designed gynecomastia cannulas are used to remove both the breast tissue and the fatty tissue, leaving behind an appropriately thin layer of subcutaneous fat under the skin without placing a visible scar around the nipple. The strokes are counted and the volume from each side, composed of breast tissue and fat, is easily seen and accounted for to achieve a balanced result. With this unique approach, a flat and handsome chest can be produced.