Then I come last year is a condition that is on the spectrum. It’s hard to say what determines the diagnosis. I suppose, if a man’s chest has a feminine appearance, then that would be a definition of gynecomastia. All people have breast tissue, men and women. In some men breast issue is overly sensitive to normal hormone levels, and develops slightly more than others. Fullness of the nail chest is generally related to three potential tissue variables. They are glandular breast, tissue, excess subcutaneous fat, and skin laxity. Skin like to be is often a contributing variable in individuals who had significant weight loss. This can be as little as 20 or 30 pounds but usually more often seen it in those who’ve lost 40 or more pounds. Older men typically also have skin laxity issues related to loss of skin elasticity. Best way to assess and differentiate. The various tissues is to put the skin and pectoralis muscle under tension which shows subcutaneous fat and glandular tissue very clearly. Do this by taking one arm at a time and placing it your forearm behind your neck like you’re scratching your upper back. With the skin and pectoralis muscle under tension by placing one forearm behind your head, you can look in the mirror or have someone take pictures and see the contour of the glandular tissue very clearly. There are no quality treatments other than surgery, so the question is really does the amount of fullness in your chest bother you enough to have surgery? That said, gynecomastia surgery can be a little tricky. Often it’s best done with a combination of Liposuction and open glandular excision. The hardest cases to treat are those who have skin laxity components. And if the messaging surgery is a fairly complex procedure, that should generally be done by those who have substantial experience with a proven track record. If you’re interested in having reduction of your chest, they suggest having multiple in person consultations. They need consultation. Ask each provider to open up their portfolio and show you their entire collection of before and after pictures of the previous men who had the same procedure with a similar chest characteristics. An experienced surgeon should have no difficulty showing you at least 50 sets of before, and after pictures of commonly performed procedures. Gynecomastia surgery is not as common as some other procedures, but it is certainly not an uncommon procedure. Results vary greatly, depending on who you choose is your provider so choose carefully, and I suggest doing that I having so many consultations as possible. Best, Mats Hagstrom, MD