Can ptosis resemble Gynecomastia? (photos)

Question

Hello. Years ago, I had lipo. My surgeon told me after the procedure that there was very little glandular tissue and that I had “pseudogynecomastia”. I had concerns cuz my lower chest still had this pointed look, though it was much improved. Two consults said further lipo was unnecessary, and after an exam concluded I’d need a mastopexy. Is this true? It looks much better than it was. However, my lower chest seems to “poke out” still. It’s soft, though. When I lift up my arm, it’s flat.

Rodolfo Castillo, MD · Answer

Hello Kensaimage, 
Based on background information and photos this could be a case of tuberous breasts, which causes the bulging of tissue under/around nipple area in "pointy" shape. This can be addressed with a gynecomastia by removing said tissue.

Sanjib Tripathee, MD · Answer

Just seeing your picture ,it seems like you have a significant glandular tissue to classify it as gynecomastia. But ,I can't be sure unless I can palpate it. If you feel, the hard tissue below your nipple its a glandular tissue. If its gynecomastia , you might need liposuction plus land excision. If there is not glandular tissue ,you might need mastectomy with skin excision.

Sang Hoon Park, PhD, MD · Answer

Hello, Based on the photos and information you provided, it looks like you have some breasts tissue left which is so-called gland. Of course, the diagnosis should be made after in-person consultation that the surgeon can actually touch the lump so it is hard to be sure for now through photo consultation. However, considering that the pointy area is right below the nipple and it sticks out in a small circular shape even when you raise your arm, there is a chance you may have actual gynecomastia than "pseudogynecomastia". Please touch the area and feel if it is a bit harder or a bit different than other fat. If it is, you may try follow up appointment and consider revision with pre-areola incision to remove the gland. For more accurate diagnosis, you should have in-person consultation with a surgeon.

Mats Hagstrom, MD (license on probation) · Answer

Skin laxity contribute significantly to creating fullness and the chest and mimics gynecomastia.

Did you have an open excision of glandular tissue or was it all done with Liposuction?

In my opinion Liposuction regardless of what device is used cannot successfully remove all glandular tissue.

If you’re not had an open excision then there may be glandular tissue that can be removed to partially improve the look.

The best way to determine what the underlying soft tissues look like is to put your arm one side at a time behind your head and stretch your skin and pectoralis muscle while looking in the mirror.

If appropriate amounts of fat and glandular tissue have been removed the patient should look just slightly over treated or slightly sunken in with the pectoralis muscle and skin under full tension.

It’s a little hard to describe with words but you are partially doing that in your first picture.

Stretch your arm all the way behind your head while looking in the mirror and you can see if there is glandular tissue to be removed.

If too much glandular tissue is removed it can create and then temptation that is undesirable so it’s a balancing act.

Skin removal on the male chest can be crude. I especially am not a fan of the donut mastopexy approach.

Best,

Mats Hagstrom MD

Can ptosis resemble Gynecomastia? (photos)

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