Age: 17/16 yr old male, breast enlarged since 5 years ago. He is very embarrassed and unable to participate in PE class, and difficult to interact with other students. Last seen MD 8-9 months ago work up Gynecomastia, result negative for any hormone-related issues. Breast Asymmetry, moderate. Loss of Breast Skin Elasticity, severe. Breast skin Stretch Marks, severe. Regnault ptosis scale: Grade IV: Severe ptosis—nipple far below the IMF points toward the floor. Procedure: Male breast reduction surgery with liposuction Anesthesia: General, Preoperative Diagnosis: 1. Gynecomastia/Mammary hyperplasia 2. Male Tuberous breast deformity 3. Bilateral breast ptosis 4. Breast asymmetry Procedure: 1. Liposuction of axillary/(anterior bra roll) area 2. Horizontal technique male breast reduction/Inferior pedicle