In men that present with excessive breast tissue, it is necessary to remove it. This is done under local anesthesia and sedation with liposuction, or direct resection through incisions on the edge of the areola, down the front and, in extreme cases, in the fold under the breast when even skin may need to be removed. Generally the patient can go home the same day using a compression vest. It is important to determine the underlying cause of the gynecomastia as additional treatment may be necessary.