The results of gynecomastia surgery can be life changing. The amount of chest flattening can be variable depending on underlying pectoralis major anatomy, the density of the breast tissue, and overlying skin tone. Some patients are able to achieve dramatically flat contours with smooth overlying skin, while others may have a more subtle improvement. The amount of tissue extracted at the time of ultrasonic liposuction and overlying skin retraction after a liposuction procedure can be variable and unpredictable. Men with well-developed chest muscles may have persistent fullness from the underlying muscle definition. Men with protuberant areola may have some persistent fullness affecting the areola despite liposuction and direct excision, with transient appearance changes related to the normal sensitivity response of the nipple. Breast asymmetry is normal; do not expect perfect symmetry after surgical intervention. Results of gynecomastia surgery are always evident, shirts fit and look better, and patients report improvements in self-confidence and self-esteem. Recurrent breast fullness can occur from weight gain, certain medications or drugs, or aging.