47 year old male who underwent gastric sleeve procedure in 2013. The patient initially weighed 600 pounds and lost over 300 pounds after the gastric sleeve surgery. He then had a mastectomy for his gynecomastia to remove the excess skin. The patient also had a history of rashes in the skin fold beneath the breast. Over 4000 grams of skin and tissue was removed from patient’s breasts (9lbs).