Pseudogynecomastia is a term used to describe enlargement of the male breast area by excess fat only, while gyneocmastia refers to enlargement of the male breast area by the proliferation of fibrous breast tissue (and fat as well in most patients).‘Pseudogynecomastia’ occurs primarily in patients who are overweight or obese. The term implies that the breast area is enlarged purely by fatty tissue, but in my experience most of these patients are found to have some excess fibrous breast tissue as well when gynecomastia surgery is performed. All men have some breast tissue behind the areola. Excess body mass in the form of fat has the ability to convert androgens (male sex hormones) to estrogens (female sex hormones), so it is not surprising that the breast tissue proliferates in many of these patients, even if it is a secondary response to obesity. Patients with ‘pure glandular’ gyneocmastia have only excess breast tissue – there is no fat to remove. Patients with ‘mixed’ gyneocmastia, the most common form of gynecomastia, have both excess fibrous breast tissue and surrounding excess fatty tissue. Patients with pseudogynecomastia and mixed gyneocmastia are both treated by liposuction, and then any excess fibrous breast tissue is removed by a variety of means (arthroscopic shaver excision and/or ‘pull-through’ technique). So from a surgeon’s perspective, there aren’t really significant differences between the two. Mixed gynecomastia patients have more fibrous breast tissue to remove while pure gynecomastia patients have less, but the approach to surgical treatment is essentially the same.