Mixed presentation, 18 years carried — combined approach.

Lived with grade-3 since puberty. Combined glandular excision plus lipo to address the surrounding fat. Six-month result is the chest he'd have had at twenty.

Cases like this one

• Grade 2·25-34

  Lean build, firm glandular core — surgery one year out.

• Grade 3·25-34

  Tattooed chest, true glandular — excision preserved the ink.

• Grade 4·45+

  Grade 4 with skin laxity — staged excision.