Your question is way to general when it should be an open ended discussion. You should first put up some pics so we can see your chest, then members such as my self that have had the surgery can give you a better anaylsis. In most cases lypo and excession should be performed together for optimum results, but not in every circumstance. Some times either or is the way to go, but again, Im not a doc and you've yet to give us anything to work with. Regardless, you are most definetely in the right place as there are lots of expert opinions and facts about gynecomastia to be gathered on this forum, so be patient, ask lots of questions, give us something to work with, and Im sure that every question you have will be answered...