Gynaecomastia is the commonest benign condition of the male breast. Management consists primarily of taking a complete history and making a thorough clinical examination. Ultrasound is recommended as the first-line imaging investigation although mammography may be added to confirm the diagnosis. The results of fine-needle aspiration cytology may be poor as an adequate yield of pathological specimens is low, and it should be reserved for suspected malignant lesions. Endocrine evaluation of gynaecomastia is rarely productive and such testing is best done selectively. Many patients can be treated simply with reassurance about the benign nature of the condition. In those patients in whom a stimulus has been identified modification of treatment may improve symptoms. Hormonal manipulation may be appropriate in younger patients, but a testicular neoplasm must be excluded. Operations should be reserved for those who fail to respond to hormones and in those with severe cosmetic deformities.