This is a 20 year old man who developed gynecomastia as a teenager. He underwent gynecomastia correction by another plastic surgeon who also performed a second revision surgery. Despite two attempts at correction of the problem, the patient was not completely satisfied with the results. He can to me for a second opinion. On examination, it was apparent that there was residual breast tissue, but fat and gland. In order to make a full correction, the patient underwent a third gynecomastia operation. This time, a thorough direct excision of glandular tissue was performed through the existing periareolar surgical scar. In order to avoid contour irregularities of the chest or dished-in contour depression, a very meticulous piecemeal excision of the remaining glandular tissue was performed. In this manner, a precise reshaping of the chest could be performed, The patient is seen before surgery and about 2 weeks post-op. Already, his chest shape is markedly improved!