The plastic surgeon must be familiar with the anatomy of the breast and be able to differentiate between the fat (adipose) tissue and the glandular tissue. In a liposuction-assisted mastectomy, the surgeon primarily targets the fatty component of the breast. The glandular tissue is quite dense and is extremely resistant to removal by any method other than direct excision. The requirement of direct surgical resection of tissue in some patients may explain the poor results obtained by some inexperienced practitioners in specific cases. As previously mentioned, longstanding stable cases of gynecomastia do not routinely require histological examination of the excised tissue.