Gynecomastia and the pinch test

Self-exam for diagnosis for gynecomastia

 

Gynecomastia is also known as “man boobs” or “moobs.” This is a breast disorder that results in a male developing a female-like breast. However, not all cases of males who are having man boobs are a result of a breast disorder as it can also be a result of being overweight. A test called the gynecomastia pinch test can reveal if it is gynecomastia or not. This article will discuss everything about gynecomastia and the pinch test to help males who go through this condition. It can help them decide whether to take a male breast reduction surgery to resolve this matter.

What is Gynecomastia?

The term gynecomastia came from the two Greek words gynec and mastos, which translates into “female-like breast.” This condition manifests when the breast tissue enlarges because of a hormonal imbalance. This imbalance happens when the testosterone levels decrease while the estrogen levels increase. Factors that cause this hormonal imbalance include:

  • Other medical conditions
  • Age 
  • Genetics
  • Massive weight loss
  • Drug use
  • Anabolic steroids abuse

 

Furthermore, this condition may be one-sided or may affect both breasts. Also, since several factors can cause it, the specific cause can remain unknown. 

 

What are the Symptoms of Gynecomastia?

Gynecomastia can occur in adolescents and adults and can have varying severity. Regardless of the severity, here are the common symptoms of gynecomastia:

  • Painful or swollen breasts
  • Breast tenderness
  • The appearance of movable tissue beneath the nipple
  • A bloody discharge from the nipple 
  • Secretion of fluid similar to breast milk 
  • Itchiness in the nipple and underarm
  • Sudden feelings of being unwell
  • Mood swings and changes in sex drive

Take note that if the male experiences no other symptoms aside from swelling and the breast tissue is fatty, this case is pseudo-gynecomastia.

If the patient is exhibiting symptoms of true gynecomastia, its severity can be assessed using a four-grade categorization.

  • Grade 1 in which the breast enlargement is minor and very unnoticeable. There is slight swelling, but there is no presence of excess skin.
  • Grade 2 in which the enlargement of the breast is moderate and unnoticeable when wearing loose clothing. There is no presence of excess skin.
  • Grade 3 in which the breast enlargement is moderate to severe and is highly noticeable. The swelling may become severe, and there is a presence of excess skin.
  • Grade 4 in which the breast enlargement is significant and severe. There is substantial excess skin and gives the male a feminine breast appearance.

 

gynecomastia before and after

Gynecomastia before and after photo

Gynecomastia and the Pinch Test: How Gynecomastia is Diagnosed

If the male is experiencing breast enlargement along with other symptoms, it is wise to visit the doctor right away for an accurate diagnosis.

To diagnose the condition, first, the medical history of the patient will be reviewed. The doctor will examine if the gynecomastia is caused by physiologic factors or is drug-induced, which is primarily caused by anabolic steroids.

A physical exam called the pinch test is also conducted to find out if the condition is true gynecomastia or pseudo gynecomastia. The patient is asked to lie down on a supine position. The doctor will then use his forefinger and thumb to examine the breast tissue. If the doctor feels a rubbery or firm mass of disk-shaped tissue beneath the nipple, then the condition is true gynecomastia. If no such tissue exists, then it is pseudo-gynecomastia.

Other tests that can be done to obtain a more accurate diagnosis may include:

  • imaging tests using a mammogram to obtain a radiologic picture of the breast tissue;
  • endocrine hormone tests to assess the levels and balance of the hormones; and
  • blood tests to assess kidney, liver, and thyroid function, which can help determine the condition’s underlying cause.
gynecomastia before and after photo

Gynecomastia before and after photo

How is Gynecomastia Treated? How is Male Breast Reduction Surgery Performed?

The best treatment option for gynecomastia is surgery, as it is a permanent solution. When the patient undergoes the male breast reduction surgery, the breast tissue will never return. Depending on the severity, the methods of male breast reduction surgery vary.

  • Breast Gland Excision with Liposuction. This is the standard procedure. It is best for patients whose condition is not yet severe (Grade 1 and 2). Also, this is regarded as the most successful way of performing male breast reduction surgery. An excision is made on the breast gland while having fat removed from the chest, and this can successfully remove the breast tissue while contouring the chest area. 
  • Two-Stage Procedure. This is the procedure recommended for patients on the Grade 3 classification. As its title implies, there are two stages for this procedure. First is the standard procedure. The second stage is called peri-areolar lift, which is done after 4 to 6 months to let the blood supply re-establish on the nipple-areola. In this stage is the skin reduction done by making an incision around the entire areola, followed by a second larger incision, which makes the tissue between the incision doughnut-shaped. The tissue is then removed, and the incisions are closed.
gynecomastia before and after, free nipple double incision mastectomy

Free nipple double incision mastectomy. before and after.

  • Double Incision Mastectomy. This is the procedure recommended for some patients on the Grade 3 and all on the Grade 4 classification. At the beginning of the procedure, the nipple-areola complex is completely removed before the incisions. The incision is larger as it extends from the breast fold up to the armpit, and it may still be larger depending on the size of the redundant tissue. Once the tissue is dissected off, the table is raised to have the patient in a sitting position to inspect the effects of gravity and how much is the proper amount of skin to make a tight and contoured chest. The nipple-areola complex position is also reviewed to make sure that it is well balanced and aesthetically correct.

Conclusion

Having feminine-like breasts is embarrassing and can greatly affect the male’s psychological health, emotional health, and social well-being. Luckily, gynecomastia can be accurately diagnosed using the pinch test combined with other tests. Furthermore, surgery is available no matter how severe the condition is, and all are proven to be successful and effective. You can read more about gynecomastia and the pinch test here: https://www.gynecomastia.org/

References:

  • Swerdloff RS, Ng CM. Gynecomastia: Etiology, Diagnosis, and Treatment. . In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext . South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279105/
  • Cuhaci, N., Polat, S. B., Evranos, B., Ersoy, R., & Cakir, B. (2014). Gynecomastia: Clinical evaluation and management. Indian journal of endocrinology and metabolism, 18(2), 150–158. https://doi.org/10.4103/2230-8210.129104
  • Vandeven HA, Pensler JM. Gynecomastia. . In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430812/