I am a 28 yr old man and I've had gynecomastia since I was about 21 years old. I have always been a very slender guy, but when I was around 20, I decided to try to bulk up. I ate a lot and worked out a lot. End result was that I did bulk up but became kind of fat (especially in the chest and belly area). I developed pointy looking man-boobs that I could not get rid of even by losing a ton of weight and eating healthy. I remember at one point I got so skinny it didn't even look healthy but my breasts hardly went away. I should also note that I have done just about everything that might possibly cause gyne. I have done steroids (for about 2 months when I was 18), smoked ridiculous amounts of pot, snorted lots of coke, drank swimming pools full of alcohol, and have been on and off various anti-depressants my whole life (I quit doing all of these things about 4 years ago, thank god!!). I should also point out that when I look at pictures of myself as a teenager, it appears that I may have had pointy nipples to a very small degree that it didn't seem like a big deal. Anyway, I never really thought of it as a problem or a self-esteem issue until my friends started teasing me about it. Being a tall, skinny guy, it was very noticible and I would even go so far as to say that it looked kind of strange. I was so relieved when I found out that I could use tape to hide it. Eventually, however the tape just wasn't cutting it. Soon, I bought one of the compression vests that Dr. Bermant on this forum advertises from time to time (the one that costs like 100$). I was really happy with this for a while too. It made me look much more normal and that effect never went away. However, I eventually developed chronic constipation, which I attribute to wearing an extremely tight elastic vest for almost 2 years (obviously I can't prove this, but its my theory anyway). The vest was always uncomfortable, would bunch up around my stomach and would give me bad stomach aches when I would eat. Finally, I said enough is enough. I managed to scrape up a few thousand dollars and started looking for a plastic surgeon. There were 3 of them who seemed to be the most reputable in my area. After talking to all 3 of them, one of them seemed like he really was listening to me and was very informative. The only problem was, he told me my procedure would be vaser lipo with possible excision. I couldn't imagine why he would throw the word possible in there, my case was clearly not pseudo-gynecomastia. I had the puffed out, female breast look for sure. Because of this, I didn't schedule a surgery with him because I had read all of the horror stories from people who went lipo only and didn't get any good results. However, I went back again to discuss with him all of the research I had done showing that lipo only would not be sufficient. He explained to me that if the gland was not too hard, the vaser lipo could remove some of it as well, and that it was important not to lose too much gland. He said that after he did the lipo, he would assess my chest to see how much gland was left and then excise if necessary. I dug really hard on the net and found a couple obscure board postings from people who had lipo only and were happy. I even found clinical trials stating that vaser could do exactly what my doctor said. For some reason, I just decided to trust this guy. He was very respectful the whole time and it seemed like he knew what he was talking about. Anyway, about 3 weeks ago, I had the surgery with that doctor, and when I came to, he told me he took about 300 (ccs? mls?) from each side and that no excision was necessary. I remember the first three days, before I even took the vest off to see the results, I would stay up all night reading horror stories on these boards about people who were extremely unhappy with lipo only. I couldn't stand the thought of trying to get another 6 thousand or going thru another surgery like this. I was so scared to even look at the results because I was so sure I would be unhappy. However, on day 3, the first day I took the vest off, I was so surprised. My chest looked......good. I couldn't believe it. Now its 3 weeks later and I swear the results look even better. I do have some significant swelling on the left side, but my chest looks flat now. It has that male looking contour. I couldn't be happier. I just wanted to tell everyone here to make sure you find a surgeon who knows what they are doing because from what I gather, THAT is what matters. I have seen a few stories here of men who get lipo + incision and get their chests jacked up permanently as well as the unhappy lipo only stories. Because of this, I think that there must be a lot more that goes into choosing lipo only vs. lipo + excision besides just having true gynecomastia or pseudogynecomastia.