Gynecomastia is common among adolescent boys and middle-aged, including older men. Hormonal imbalance, medication side effects and declining testosterone levels are the usual suspects.
Pseudogynecomastia, on the other hand, can happen to men regardless of age group. This condition is usually brought on by the presence of excess fat primarily in the chest area. However, due to their similarity in appearance – the best method of confirmation is via a doctor’s assessment.
What is Gynecomastia and Pseudogynecomastia?
Gynecomastia is caused by hormonal imbalance, which is the result of excess estrogen being produced. Changes surrounding sexual development in teenage boys and health issues such as thyroid problems common among men in their 50s and above are some of the causes of this hormonal imbalance. The side effects of some medications can also potentially be a cause.
In men, the fat tends to accumulate in the chest and abdomen areas. Fat amassed around the chest area usually results in a puffy or swollen appearance clinically known as lipomastia, adipomastia, or pseudogynecomastia.
Low Metabolism and Body Fat
Poor dietary habits and lifestyle choices easily contribute to a host of issues, including weight gain and the accumulation of excess fat. Excess fat often results in slower metabolism and testosterone levels and the production of aromatase. The aromatase enzyme converts testosterone to estrogen.
Men produce estrogen, albeit at a lower level compared to women. When a man’s body produces excess estrogen, the more the likelihood that excess fat will be stored. An area where this excess is usually more prevalent would be that of the chest or breast. This is what commonly causes pseudogynecomastia.
When the body produces excess estrogen, the more the likelihood that excess fat will be stored. Fat also causes the body to produce the aromatase enzyme. This enzyme converts testosterone into estrogen and is responsible for slowing down metabolism, which slows down the body’s ability to burn fat – you will lose fat but in lesser amounts. If not addressed, this can lead to more fat being stored causing an imbalance to the body’s hormone level.
An increased estrogen level in men also results in loss of muscle mass, fatigue and mood swings.
Low testosterone levels cause an increase in fat storage as the body’s fat-burning capability is reduced. This results in weight gain and the production of excess estrogen. One common sign of low testosterone sign is a decrease in libido. Frequent fatigue is also a sign in men.
What is the difference between Gynecomastia and Pseudogynecomastia?
Both the male and female breasts are made up of glandular and fatty tissue. In gynecomastia cases, it is a proliferation of both types of tissue. As for pseudogynecomastia, it is usually the case of excess fatty tissue.
Do I have Pseudogynecomastia?
There are simple self-check methods that one can carry out. For example:
- Appearance: Does your chest area look evenly enlarged?
- Excess fat: Is your exercise or workout routine not addressing the excess fat around the chest?
- Pain: Is it painful or does the area around the areolas when touched? (this could be a sign of gynecomastia)
The above list is not confirmation indicators. A trip to the doctor’s for a qualified assessment is highly recommended. Do take note that it is possible for an individual to suffer from both gynecomastia and pseudogynecomastia.
Pseudogynecomastia treatment options
There are options to select from, and these include:
- Weight loss and exercise: Adopt a comprehensive programme that promotes both weight loss and healthy eating habits. These may consist of resistance training and a caloric deficit diet
- Compression wear: Compression garment in the form of tops, for example, does help in terms of appearance and according to some, improving blood flow. Improved blood flow has been known to increase fat oxidation.
- Liposuction: Liposuction is currently the proven clinical treatment for treating pseudogynecomastia. During this procedure, excess fat cells are removed. It is only to be performed by a qualified doctor who is accredited by MOH Singapore to perform this procedure. The costs may vary, depending on the patient’s clinical condition and complexity of the surgery.
If you have any questions, feel free to ask me!
Dr Ivan Puah has spent more than 15 years performing FDA-approved injectables, skin lasers and body sculpting surgical procedures. From his patients’ diverse concerns, he predicts the cosmetic surgery trends for 2020.
SINGAPORE, Jan. 22, 2020 /PRNewswire/ — Dr Ivan Puah, Medical Director of Amaris B. Clinic, who is accredited by the Ministry of Singapore to perform surgical body sculpting treatments, has seen a plethora of diverse concerns from 25- to 65-year-old male and female patients in Singapore.
1. Rejuvenation Biostimulation Is The Treatment That Is Getting Popular With The Advent Of Tech Device Usage
As more people rely and get subconsciously overly fixated on their modern communication devices such as smartphones and laptops, Dr. Ivan Puah has noticed a rise in the case of Text Neck. Text Neck describes the pain and damage sustained on the neck and shoulders from looking down at one’s device for an extended period. The physical stress causes skin damage on the neck leading to visible deep horizontal lines across the neck.
One of the most effective treatments for this is a treatment called Rejuvenation Biostimulation. It is the use of hyper-diluted calcium hydroxyapatite fillers that stimulates stem cells into regenerating collagen in combination with the use of energy devices that produces focused ultrasound energy. “These combined modalities can effectively improve facial and neck lines as it encourages skin rejuvenation,” Dr Ivan Puahsaid.
2. Gynecomastia, or Enlarged Male Breasts, Is More Common Than You Think
Gynecomastia occurs when excess glandular tissue is produced. When an abundance or excess fat appears in the chest area, it is known as pseudogynecomastia (fake/faux gynecomastia), which can be treated with liposuction alone. “In my experience, most patients who complained of pseudogynecomastia are later found to have true gynecomastia after medical assessment,” shared Dr Puah.
“Due to the high volume of patients I see regarding their gynecomastia concerns over the years, I have designed a customised 4-step gynecomastia surgery program called 4D Chest Remodelling. It reduces fat tissues and removes excess glandular tissues while stimulating the production of subdermal collagen to induce tissue remodelling and production of new collagen and elastin.” Unlike the standard gynecomastia surgery, 4D Chest Remodelling is a more complex treatment modality especially planned for those whose ultimate objective is to achieve flatter and sculpted chest using high definition body sculpting technique.
3. Nose Enhancement With Thread Lift Is Gaining Fast Popularity
Nose Thread Lift is quickly becoming one of the more sought-after treatments when it comes to achieving a more natural appearance. It is a treatment that is surpassing the popularity of nose fillers when it comes to non-surgical rhinoplasty. “The reasons for the decline in popularity of nose fillers includes complications and migration of fillers,” said Dr. Ivan Puah.
HIKO Nose Thread Lift uses absorbable PDO thread to achieve a higher nose bridge without the need for surgery. These threads are placed carefully in the nose to heighten the nose bridge. Dr Puah added, “PDO material has been in use for more than 30 years in various medical disciplines such as plastic surgery and gynaecology treatments because of its high tensile strength, good pliability and smooth tissue passage.“
4. Natural Look & Customised Treatments Are Much Preferred
“Unlike the past where many preferred dramatic results, my patients today are opting for treatments that produce natural-looking results. This includes facial and body enhancement treatments with fat grafting,” shared Dr. Puah.
Facial Fat Grafting’s goal is to restore loss volume to the face, that is often associated with youthfulness. It uses a patient’s own fat tissue, in tiny amounts, removed from excess fat pockets and then injected into areas of the face where needed.
For fat grafting on the body, ADR-C Breast Enhancement is popular among women who are looking to add volume to their chest while removing stubborn pockets of fat on the body. It works by removing fat tissues using the micro-lipo technique from parts of the body where there is a substantial amount of fat, such as the abdomen or saddlebags. The fat is centrifuged to maintain the integrity of the fat cells and then injected into the areas in the breast where the volume is lacking.
5. Hourglass Body Shape Is Out. Toned Body Is In.
The hourglass body shape, as commonly seen in the media, is one of the body types that most women covet. “In Asia, however, the hourglass body shape is not the preferred body shape but the toned body is,” said Dr Ivan Puah. Hourglass body shape comprises of a pair of voluptuous breasts, small waist and curvaceous hips. He added, “Many Asian women do not like heavy bottoms as it resembles a pear shape and they have instead expressed their preference for the toned and proportionate look – one that complements their frame and height.”
ABOUT DR. IVAN PUAH
Dr. Ivan Puah is the medical director of Amaris B. Clinic, a medical aesthetics clinic in Singapore. He obtained his VASER® Body Sculpting training in Colorado and Argentina. Additionally, he also received training and guidance in syringe liposculpture, fat grafting and thread lift by renowned French plastic surgeon, Dr. Pierre Francois Fournier. He further honed his surgical skill in gynecomastia surgeries in San Franciscounder the mentorship of Dr. Miguel Delgrado. In Singapore, Dr. Ivan Puah is accredited by the Ministry of Health to perform surgical body sculpting procedures. Dr. Ivan Puah holds a Graduate Diploma in Family Dermatology from NUS and Graduate Diploma in Acupuncture from TCMB. He is also the appointed trainer on Botulinum Toxin and Dermal Fillers for Merz, Newton Cog Thread and PICOCARE Laser from Venusys Medical.
OTHER SIGNATURE AESTHETICS & SCULPTING TREATMENTS AT AMARIS B. CLINIC
Started in 2004, Amaris B. Clinic has been providing medical aesthetics and body sculpting services. Amaris B Clinic’s forte lies in body sculpting – surgically removing stubborn fat pockets to sculpt and shape different areas of the body through a variety and combination of services offered. Amaris B. Clinic received recognition as the “2019 Body Sculpting Provider of the Year in Asia Pacific” by Global Health and Travel. The clinic’s signature treatments include:
If you have any questions, feel free to ask me!
Typical journey of a gynecomastia patient
Typically, a guy who is unhappy with the size and shape of his breasts and nipples and who has been suspecting that he may have gynecomastia, will call up or write in to enquire about treatment options for his condition. We will then set up a consultation appointment for the patient.
A detailed clinical assessment will be conducted to confirm the diagnosis and to evaluate the causes of the condition. Our doctor will walk the patient through the treatment options, the expected results and potential complications.
The surgery will usually take about an hour and the patient will be able to return home to rest after the treatment. No hospitalisation is required.
Based on our experience, patients will be able to perform most of their daily activities within 1-2 days post treatment. However, most will require up to 2 weeks to resume rigorous activities such as sports and gym work-out.
Our medical team will follow our patients’ recovery for the next 3 months. For some patients, skin tightening and scar treatment may be offered during this recovery period to help optimise their results.
Gynecomastia surgery cost
In Singapore, the procedure may cost between S$6,000 and S$15,000. What constitute to $6000 and what constitutes to $15000?
Treatment required will depend on the condition of the affected patients. For instance, gynecomastia can be classified into different categories based on the the gland sizes, surrounding fat layers and skin laxity. The treatment options, approach and complexity may vary. Strictly speaking, there is no ‘one-size-fit-all’ treatment for gynecomastia.
An interesting question I have been asked before is that, “Since gynecomastia is on breasts reduction for men, can women go for it too?” Breast gland reduction for male gynecomastia is different from breast reduction surgery for female.
Liposuction may be helpful for women with excess fatty breast layers, achieving certain degree of reduction, sculpting and lifting. Do note that women with significant breast hypertrophy may ultimately require breast reduction surgery.
The cause of “physiologic” adult gynecomastia is not known, and it is likely to be multifactorial. One of the possible factors is the age-related declines in serum testosterone after 30 years of age in males.
The answer to the common question of “Can gynecomastia cause low testosterone?” is that gynecomastia does not cause low testosterone, but conversely, low testosterone may possibly increase the risk of developing gynecomastia in males.
Does gynecomastia reduce libido?
Low testosterone level reduces libido, not gynecomastia.
Does gynecomastia contribute to low sperm count?
Low testosterone, not gynecomastia is one of the many possible causes of low sperm count.
Does gynecomastia result in erectile dysfunction?
Gynecomastia does not result in erectile dysfunction directly. It is not uncommon for patients who suffer from gynecomastia to have low self-esteem, social phobia, anxiety and even depression. Those psychological issues, if persistent and severe, may cause patients to suffer from erectile dysfunction.
The relationship between low testosterone and gynecomastia
Gynecomastia is a complex process resulting from many hormonal changes in the body. Estrogens strongly stimulate, and androgens (such as testosterone) weakly inhibit breast gland growth. The imbalance between estrogen actions relative to androgen action at the level of breast tissue is believed to be the main etiology. Various hypotheses have been put forth to explain the etiology of gynecomastia, including: elevated estrogen levels; lowered free testosterone; abnormal testosterone-to-estrogen ratio; increased peripheral conversion of testosterone to estrogens . However, for most patients, the etiology still remains unclear.
In addition to treating gynecomastia, you may want to treat low testosterone
Testosterone levels in men tend to decline with age. Patients with low testosterone levels require a thorough medical evaluation. Clinical assessment and lab investigations are required to identify possible underlying causes such as medical illness, lifestyle or ageing factors. If there are underlying causes for low testosterone, the patient will be referred for individualized treatment for these causes.
The low testosterone levels can be supplemented by hormones prescribed by a doctor. Regular follow up will be required for the patients.
Gynecomastia or enlarged male breast is more common than some may think than pseudogynecomastia. Some may think their enlarged male breasts are due to weight gain but most of my male patients have a combination of both. Can fat freeze cure your enlarged male breasts?
Nothing can fix gynecomastia except for gynecomastia surgery?
Not exactly. Gynecomastia can be treated or resolved spontaneously if the underlying causes can be treated or reversed in a relatively short period of time. In most cases, gynecomastia is unlikely to completely resolve if the condition persists for more than 1 year. After that, surgery is the treatment of choice.
You are probably suffering from pseudogynecomastia. What is pseudogynecomastia?
“Man-Boobs” or male breast enlargement can be due to breast tissue hypertrophy (gynecomastia), fat tissue hypertrophy (pseudogynecomastia) or a mixture of both. Most of my patients (75%) suffer from a combination of both, 20% of them had only gynecomastia, and less than 5% had pure fat hypertrophy or pseudogynecomastia. It is relatively uncommon for patients to only have pseudogynecomastia when they present with symptoms of breast enlargement.
Fat Freezing for men’s breast tissue: How Does fat freezing Target Fat in Men’s Breasts?
Fat reduction treatment such as fat freezing uses a controlled cooling mechanism to ‘freeze’ targeted fat tissues. This will lead to damages to the fat tissues. The ‘injured’ or damaged fat tissues will then be removed from your body.
Fat freezing can be effective for pseudogynecomastia in some male patients. How does it work?
For those who are not ready for surgical treatment, fat freezing is probably the next best option for pseudogynecomastia. However, you will need to have a realistic expectation as Fat Freezing may reduce only up to 20-25% of existing fat tissues. For patients who do not respond to the treatment, breast liposuction will have to be considered next.
You will need to be evaluated first to know if you are a good candidate for treatment. Who makes a good candidate for gynecomastia? Who makes a good candidate for pseudogynecomastia?
As mentioned earlier, 90-95% of the patients with ‘man-boobs’ that I see have some degrees of breast tissue enlargement, with and without associated fat tissues. These patients will not respond well to fat freezing or fat reduction alone. Just reducing the fat tissue alone, may lead to unsightly results such as puffy nipples, asymmetry, and so on.
It is crucial to have the right diagnosis before subjecting patients with male breast enlargement for Fat Freezing treatment, as only a small percentage of the patients will truly benefit from it.
What happens during the fat freezing procedure?
It will be performed with the patient lying comfortably on a bed. The specialised membrane will be applied on the chest to protect the skin from cold before applying suction paddles to the treatment areas. Then, using controlled cooling, fat tissues will be cooled till they crystalised. The whole treatment will take approximately an hour.
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