I think (and I'm no doctor) that despite what any surgeon tries to tell you, UAL isn't as effective on gland as a direct kind of excision would be. Dr. Bermant usually posts a response to this type of question stating that studies have show UAL to not affect women's breast glands when doing lipo in that area. To his knowledge, there is no difference between the gland of gynecomastia and a woman's normal breast glands so UAL can't work both ways. I would say the vast majortiy of people who have had lipo only (like me), and have gland underneath the areola (me also), only excision can get you that kind of flat nipple (I've learned this the hard way).