Do I have true gynecomastia or pseudogynecomastia. (photos)

Question

Age 24. Started weight loss on June 7 with 1700-1800 calorie diet starting weight of 216lbs body fat 23.8% 6ft tall ... Currently weigh 191 and am wondering if I just have excess chest fat or true gynecomastia I've been overweight and had boobs pretty much my whole adolescence and adult life do I need to just continue dieting and exercising or will surg/liposuction be needed at what weight and bf% will I notice a difference if it's just chest fat?

Carlos Mata, MD, MBA, FACS · Answer

Hi Bzapp,

Thanks for your question and photos. It is impossible to know for sure without examining you. I would think that based on your description that you have gynecomastia and surgery will likely be required. Please seek several consultations to get different opinions. The %BF is does not matter but you should be at a stable weight to get the best results. The surgery can be performed with a combination of ultrasound, liposuction and direct excision using a one-stitch technique of minimally invasive gynecomastia surgery. It routinely takes just 40-50 minutes and can be done under local plus sedation. Good Luck!

All the best,

Carlos Mata MD, MBA, FACS

#gynecomastia #moobs

Board Certified Plastic Surgeon

Larry S. Nichter, MD, MS, FACS · Answer

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.

Austin Hayes, MD · Answer

It's a good question, but unfortunately you cannot tell without physical examination. Physical exam allows the surgeon to palpate breast tissue under your nipple. If this is present, a typically needs to be excised surgically. If only fat is present on physical examination, and there's no excess skin,  then you could consider liposuction alone.

Jed H. Horowitz, MD, FACS · Answer

There are several common factors which contribute to gynecomastia. These include excessive levels of #estrogen, natural #hormone changes, use of recreational drugs or alcohol, medications and their associated side effects, and, various health conditions. Also, there are different types of #gynecomastia.Normal Gynecomastia is usually apparent in boy between the ages of 12 to 15 years old and older men 65 years old or more who experience a drop in their testosterone levels. This type of Gynecomastia takes about one to two years to regress on its own.Pure Glandular Gynecomastia is seen more commonly in body builders and is caused by steroid use. Surgical removal of the gland is required for treatment.Adult Gynecomastia – Fat deposits are apparent in the glandular tissue. This type of gynecomastia is the most common. Doctors may recommend surgery for treatment of the condition.Adolescent Gynecomastia is hereditary and usually appears in 30% to 60% of boys between the ages of nine to fourteen. Many cases of adolescent gynecomastia resolve on its own as the boy grows into adulthood. Some may choose to undergo surgery to correct the situation, this usually happens at the age of 18 or above. In severe cases in young boys, the physician and child development specialists will need to speak to the parents regarding the severity of the gynecomastia and if surgery is an option before the age of 18.Assymetric or Unilateral Gynecomastia appears in either one or both breasts at different degrees. In many cases one breast appears larger than the other. Surgery is a common treatment for this type of gynecomastia.Pseudo-Gynecomastia is composed of adipose tissue instead of glandular tissue. This type of gynecomastia can be treated with diet, liposuction or surgerySevere Gynecomastia commonly affects those who have lost skin elasticity at an older age and those who have been obese or overweight at one point in their life and lost weight may have saggy skin and breasts that are severely enlarged. Surgery is the recommended treatment for severe gynecomastia. There are three types of surgical treatment options available that treat gynecomastia. The doctor will recommend the one that is best suited to each individual case.

Tim Neavin, MD · Answer

Congratulations on your weight loss! By your history and appearance, there appears to be fat and glandular excess.  There may even be skin redundancy.  The treatment would included liposuction of the chest with partial gland excision with the hopes that your skin will tighten. You should have a fantastic result.

Richard Silverman, MD · Answer

From your description of history and your appearance, I would suspect that you have true gynecomastia with a significant fatty component to it. You would see some improvement with weight loss, but typically, this only gets so far, and surgery is required to get complete resolution of the condition. Describing it as "true" versus "pseudo" is somewhat irrelevant, since even if it's just fatty tissue, that fat typically is diet-resistant, so surgery is still often the thing that's needed to make it better.

Robert D. Wilcox, MD · Answer

Dear bzapp91,

To determine positively requires a physical examination. The easiest way to tell is to pinch the excess breast tissue you have there. Does it feel like there is firm hard tissue within it or does it feel soft like the fat of your abdomen? If it is true gynecomastia liposuction alone will not correct the problem, and you will need excision of the glandular tissue. It will also be important to make an assessment of the skin elasticity to be sure that the skin will recoil properly after the procedure. Be sure you seek a board certified plastic surgeon who does many of these cases each year.

I hope this has been helpful.

Robert D. Wilcox, MD

Mark D. Wigod, MD · Answer

Pseduo gynecomastia implies more fat and less breast tissue versus true gynecomastia.  Aside from perhaps recommending pre op weight loss to a maintainable healthy BMI, I would still form my operative plan based on how firm the tissue feels, how much extra skin there is, and the relatively elasticity of the skin.

George H. Pope, MD · Answer

Congratulations on the weight loss!  Keep up the good work.  You appear to have a pretty loose skin envelope on your chest wall.  This is common after a good bit of weight loss.  The good news for you is, you are a young guy and over the next 6 months or so your skin envelope should shrink.  Regarding what you have, it's tough to tell without an actual physical exam.  Gynecomastia patients have true breast tissue or "gland" which is easily palpable, and pseudogynecomastia patients pretty much just have fatty tissue.  But either is undesirable and can be corrected.

Derby Sang Caputo, MD · Answer

Hello,  thank you for sharing your doubts and photos.   Congratulations for losing weight with your low calories diet.   Probably you have a combination of both: Gynecomastia and Pseudo gynecomastia.   This can be determined with an ultrasound of your chest area.  Liposuction and open resection of the gland will be required if you have the two conditions.  However, you should always consider that massive weight loss patients that have liposuction may end up with more sagging skin.   In these cases skin removal may help.  Have a great day.

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