"Gynecomastia is a benign enlargement of the male breast due to a physiological or pathological hormonal imbalance between estrogens and androgens in the serum. Managements of gynecomastia that have been advocated are radiotherapy, hormone therapy and surgical therapy. Most observers believe that radiotherapy offers no improvement and may be dangerous, and hormone treatment has been disappointing. Surgical removal is the most effective method for the correction of gynecomastia. Several approaches for surgical treatment have been reported. Some problems arise in patients who have significant enlargement and ptosis of the breast that will require skin reduction and in patients requiring nipple-areola complex reduction. Our technique involving the circumareolar approach with purse- string suture yield a good results including male chest shape, with fewer complications, in patients with severe ptotic breast that have skin redundancy combined with areolar enlargement. From August, 2001 to February, 2004, among a total 10 gynecomastia patients, 4 male cases with skin excess and large nipple-areola complex were treated using a circumareolar approach. All patients achieved a good aesthetic contour of the chest. One patient required a revision of the widened circumareolar scar and one patient had a temporary paresthesia postoperatively. "