Affecting at least 60% of all men at some time in their life is the development of female-type breasts, which is caused by a condition known as gynecomastia. The most prevalent time this occurs is the adolescent years as young men pass through puberty and experience hormonal changes. As their hormones are changing and the estrogen level is temporarily high, they may have what is referred to as “puffy nipples.” Fortunately for most, their gynecomastia will resolve on its own without any intervention. However, for some, if their chest is not back to normal after two years, it may be permanent, with gynecomastia surgery as the only effective option.

Gynecomastia Causes

Overall, there are many different factors that can cause gynecomastia or breast enlargement in males. The most common cause is a hormonal imbalance with estrogen levels being higher than testosterone levels, while certain medications may also lead to male breast enlargement. Anabolic steroids can also lead to gynecomastia, which is common among the bodybuilding community.

True Gynecomastia and Pseudo-Gynecomastia

True gynecomastia occurs when there is excess glandular tissue in the male breasts along with excess male breast tissue resulting in enlarged male breasts. Surgical treatment is often the best solution for true gynecomastia.

It is important to note that true gynecomastia should not be confused with false gynecomastia, or pseudo gynecomastia, which results in enlargement of the male breasts due to weight gain, excess fat, and fatty tissue on the body. The main cure for pseudo-gynecomastia is often weight loss.

Gynecomastia Grades

Gynecomastia can be divided into different grades to determine severity. These grades include:

  • Grade I: severity is mild with enlargement centered around the areola. At this grade, gynecomastia is usually not noticeable with clothing.
    Grade II: enlargement is moderate without excess skin past the areola. At this stage, gynecomastia can still be concealed with loose clothing.
    Grade III: enlargement is moderate with excess skin. At this point, the swelling of the breast tissue is moderate to severe, and is highly visible.
    Grade IV: significant enlargement with feminine-type breasts and excess skin. This is the most severe stage of gynecomastia.

The severity of the gynecomastia will determine how the male breast reduction surgery is to be performed. It is imperative to select a board-certified plastic surgeon that has extensive experience with gynecomastia.

For patients with mild to moderate gynecomastia, the less invasive “pull-through technique” procedure may be an option. For those with more severe gynecomastia, a “Two Stage Procedure” may be necessary in order to reduce the excess skin.

Schedule a Consultation

If you are tired of living with the symptoms of gynecomastia and are ready to make a change, contact Dr. Delgado in San Francisco today! Your first step will be to schedule a one on one consultation appointment to discuss your concerns and gynecomastia treatment options.

Gynecomastia in San Francisco FAQs

What is the most severe grade of gynecomastia?

The most severe grade of gynecomastia is grade 4, which involves severe levels of excess breast tissue and glandular tissue. This excess tissue will create a noticeable condition regardless of whether the patient is wearing a shirt.

What is the best treatment for Gynecomastia?

Gynecomastia surgery is often the best way to treat gynecomastia. This surgical procedure is performed to correct moderate breast enlargement through the removal of excess glandular and fatty tissues.

Do all adolescent males experience gynecomastia?

No, not all adolescents will experience gynecomastia symptoms. However, most males do experience gynecomastia during their teen years as this is when their hormones are fluctuating.

 Does gynecomastia cause breast pain?

For some males, gynecomastia can cause the breasts to be tender or painful to the touch.

Dr. Delgado Bio


Dr. Delgado, MD is a world-recognized plastic surgeon and specialist in the treatment of male breast enlargement, also called gynecomastia. He has developed new techniques and owns and operates, which has become the largest gynecomastia forum in the world. Dr. Delgado holds the two most coveted credentials; the certification by the American Board of Plastic Surgery and membership in the American Society of Plastic Surgery.