Gynecomastia or stubborn fat? Is surgery worth it? Is it simply fat and I should workout more? (Photos)

Dear ballerau,it is hard to tell for sure without an examination. I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Healthy male patients with excess breast tissue or unwanted breast 
development who have no underlying breast disease.Men who desire 
improved physical and aesthetic appearance should have realistic 
expectations based on their condition and the procedure performed. You 
should meet with a board certified plastic surgeon to be able to get a 
formal diagnosis and to be able to decide on a course of treatment if 
necessary.

If you have had male breasts for more than 2 years it is probably permanent and can only be removed by surgery. If it is caused by fat alone, (known as pseudo-gynecomastia) diet and exercise, liposuction or even CoolSculpting may resolve it. However, most men have "true gynecomastia" made up of fat and breast tissue which can only be removed by surgery. Only you can determine if surgery is worth it, how much does it bother you? Be sure to be seen by a Board Certified Plastic Surgeon who specializes in gynecomastia. Good luck.

As thin as you are I do not feel you will resolve your issue with diet and exercise alone. I do a lot of gynecomastia surgery and always start with liposuction that gets rid of all or most of the fullness. After the liposuction, if I still feel excess tissue I open under the aerola edge and excise the tissue which I have to do about 50% of the time. See a plastic surgeon who does a lot of gynecomastia work. Good luck.

Thanks for your question.You can work out some more but I think you will still maintain that puffiness in the area around the areolas. You would benefit from liposuction alone and this may well settle the problem. You could consider liposculpting with promeltor/vaser/ coolsculpting but this might not be requireed. It depends on your skin laxity and how much the skin will retract following liposuction alone. I think if you did go down the route of liposuction with skin tightening, this would really enhance the result you are trying to achieve.The final thing to bear in mind, with any form of liposuction, is the possibility that the skin will not retract back and will hang loosely. If this is the case then you would need surgery to remove that extra skin. I hope that is helpful for youBW

Thank you for your question and photos. Based on these photos, you have both. You have some fat and also glandular tissue which tends to make the nipple-areolar complex puffy. You would do best with VASER Hi Def Lipo of your chest. Just to remove the gynecomastia strictly, will still leave you with flatter, but a "soft" chest. Would not waste my money on Coolsculpting, does not remove breast tissue and poor all around result.I use the VASER to sculpt the chest, remove the fat beyond the gynecomastia, in the space between the lateral pectoralis major muscle and the anterior border of the latissimus dorsi muscle, deepen the midline between the pectoralis muscles and remove fat just below the areolae, too. This will promote skin tightening, your nipple-areola will become smaller and heal to the lower border of the chest muscle where it belongs. I use stealth incisions, within the areola (the pigmented skin around the nipple) and in the arm pit. I remove the breast tissue through this same 1cm incision.See a board certified plastic surgeon experienced in advanced body sculpting techniques. Good luck.

I would recommend an in person examination to evaluate your condition and offer an accurate diagnosis. Breast tissue is not affected by weight loss. Surgery can improve symmetry. Cost varies from surgeon to surgeon, and you can check coverage with your insurance.
Seek aboard certified plastic surgeon who performs many of these procedures, has great reviews and photos, and is an expert in this field.

I would certainly urge patients to be as close as possible to their ideal weight and in the best shape possible prior to surgery. I regularly see men in excellent physical shape with low body fat who have unwanted fullness in the chest. This fullness is gynecomastia and it can only be treated with surgery. In some men, there is puffiness behind the nipples. In others, there can be a dome like shape extending from behind the nipple area. Gynecomastia surgery can provide a permanent change that can be life changing for many men. Look for a plastic surgeon with considerable experience. The goal is to have a smooth result with scars that are barely perceptible. 

You do appear to have gynecomastia from the pictures.  Your story also corroborates gynecomastia.  Many men feel as though no matter how hard they work out, they can not get the chest they want.  Removal of the breast bud and liposuction of the fat will help to improve the shape of your chest and would allow you to see results from working out but you would need a physical exam in order to determine this.  Cool sculpting only treats subcutaneous fat and would not be a recommended procedure for gynecomastia.  I perform a hidden incision, no drain gynecomastia surgery.  Patients have excellent results and I am able to remove both the breast bud and fat with a single hidden incision on almost all patients.  Patients are much more comfortable without drains, and by avoiding drains, they do not have an extra incision on the chest.

You pretty clearly have low grade gynecomastia going on. That's unlikely to resolve spontaneously at your age. The good news is that you have modest skin expansion such that a simple surgical removal of that should give a good cosmetic result.