Gynecomastia is usually asymptomatic; however, it can be associated with pain and tenderness of the mammary gland. In the last decades, several studies have examined various pharmacological agents as therapeutic options for treatment of pubertal gynecomastia. However, solid evidencebased data is insufficient to establish a standard-of-care. In grade I, the enlargement is caused solely by glandular proliferation without adipose accumulation. Surgical correction involves mammary adenectomy performed by a semicircular inferior periareolar incision. Liposuction is not required. Grade II is characterized by excessive glandular tissue and local adiposity. In these cases, liposuction and surgical excision must be combined in the same operation. Mammary adenectomy without liposuction leads to unsatisfactory outcomes, with an uneven surface or asymmetry. In grade III, the operation begins with liposuction and is followed by glandular excision with periareolar removal of the tissue. It is necessary to detach the excess skin to obtain a good chest silhouette. The hallmarks of grade IV are severe ptosis and a large amount of redundant skin. One of the techniques for reduction mastoplasty is used to remove gland and skin and flatten the chest outline. The gold standard treatment for gynecomastia is surgery involving liposuction and tissue removal. Used individually, liposuction or tissue removal produces compromised results and patient dissatisfaction. As an exception, body builders with little or no body fat require only a glandular mass removal. Gynecomastia tissue is identified on physical examination as a well-defined, firmer mass, centered at the NAC. It is rarely “rubbery,” as it is often described in clinical definitions. The perimeter of the mass is easily discerned and marked preoperatively. Complete removal of the gynecomastia tissue creates a significant tissue void between the subareolar space and the underlying pectoral fascia. Untreated, this defect may result in distortion of the NAC (ie, “donut” or crater deformity) as well as scar adherence between the NAC and muscle. The adjacent normal tissue could be recognized and mobilized to reconstitute a layer of subcutaneous tissue, filling the void and supporting the NAC. This surgical maneuver was elegantly described in an undeveloped form by Jerome Webster in 1945 as the joining of adipose tissue after gynecomastia removal to form a uniformly thick layer over the pectoral fascia so, the nipple must not be allowed to adhere directly to the pectoral fascia, nor must there be a concavity in the mammary region.