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Is it fat or breast tissue? What is pseudogynecomastia?

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Is it fat or breast tissue? What is pseudogynecomastia?
« on: July 05, 2013, 08:13:18 AM »
Is it Breast Gland or Fat?

A frequent question on gynecomastia.org has been asked many times: are my man boobs made up of fat and breast tissue or just fat?

Sometimes the debate is framed using the terms “pseudogynecomastia” (breasts comprised of fat alone) vs. “gynecomastia.”  No matter what words are used, in my view it’s not useful to spend time and money worrying about this.  

That said, from the conversations I have had with thousands of gynecomastia patients, I have come to understand the psychology behind the question.  Men seem less able to deal with the notion that they have excess breast tissue present than the idea that they have fat on their chest.  Many don’t want to think that they have “female” attributes.  Others believe that if the problem is related to fat alone, they will be able to conquer it with diet and exercise.

In my opinion, any excess tissue on a male chest should be considered gynecomastia (the same way that any amount of tissue, fat or gland, on a woman is called a breast no matter what the size).  When a man has moobs, there is always breast gland present as well as fat.  The ratio of each type of tissue varies from individual to individual.  There’s no way a doctor can examine a male chest and determine how much gland there is or what the ratio is.  A layperson has even less chance of figuring this out.  That is why I am amused sometimes when a guy writes on this forum that he can feel "something" and then sets about trying to describe it and ask if it is gynecomastia.

Some doctors will order a mammogram or ultrasound to determine how much breast tissue is present.  But this look inside the breast does not change the surgical approach one bit (though it may change the budget available for surgery).  Most often a combination of liposuction and gland excision is needed.

In some cases, one can get an idea about breast tissue directly under the areola.  If you lay down flat and then look at your chest, sometimes the areolas will protrude above the surrounding skin.  That is definitely breast tissue.

If the gynecomastia has been present and stable for over 2-3 years, understand that no amount of diet or exercise can totally remove it.  The gland component isn’t affected at all, and though the fat component of gynecomastia may diminish somewhat with extreme weight loss, it’s never enough.  When a man puts weight on, the first places it goes is the chest, the abdomen and the love handles.  As most guys will attest, these are the last areas where fat is lost —- if at all.  

I feel the term “pseudogynecomastia” is misleading in more than one way.  Not only are moobs containing fat alone virtually non-existent, the “pseudo” prefix implies that perhaps the condition is not real or worth solving.  Nothing could be further from the truth.  No matter how much gland tissue vs. fat lies under the skin, any excess tissue should be called gynecomastia. If you have it, and it bothers you, it’s worth addressing.

Dr Jacobs


Linkback: https://www.gynecomastia.org/smf/index.php?topic=27922.0
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi


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