When the gynaecomastia is large it is often necessary to excise skin to get a good result. Unfortunately this leaves fairly visible scarring. In this case – a 67-year-old white male on estrogen for prostatic cancer – a decision was made to accept some loose skin in order to avoid the scar. The gynaecomastia was therefore reduced using liposuction alone. No nipple work was necessary. The resulting skin looseness is age-appropriate.