How can I tell between gynecomastia vs. pseudogynecomastia?

How can I tell the difference between gynecomastia and pseudogynecomastia? I am pretty out of shape and wish that I worked out more. I have developed a pretty fatty breast area. With that said, I lean towards the fact that I am just fat and do not have a medical issue. Are there any specific ways to tell?


M, 33, Tennessee

Tags:man age 25-34 chest breasts too large gynecomastia

The difference between real gynecomastia and so-called "false gynecomastia" or pseudogynecomastia is that the former involves actual breast tissue growth, while the latter is simply the result of excess adipose tissue.

You can usually tell the difference between the two by feeling the nipple and areola area with your fingers. If you feel a stiff mass of fibrous tissue beneath the areola -- and this tissue feels different from the fatty tissue which surrounds it -- you very likely have "real gyno". If the entire breast area feels uniformly similar, without a firm mass beneath the nipple, you may have pseudogynecomastia.

You should also take into consideration whether or not you fall into one of the "at risk" groups for developing gynecomastia:

Men who develop gynecomastia often see an onset of symptoms after the age of 50. If you’re in your teenage years: 70% of teenagers and adolescents may also see a swelling of breast tissue. The effects of this increased breast tissue may be temporary or permanent.

There are also certain medical conditions that can cause gynecomastia while some medications include potential gynecomastia among their side effects. If you suffer from low testosterone or are taking one of these medications that includes gynecomastia as a possible side effect, you may have real gynecomastia.

If you're not sure, I encourage you to come in for a consultation and a proper diagnosis. Always remember to consult with a board-certified plastic surgeon if you're considering plastic surgery.

Hi ViperOne: 

Think of a mature female breast as a full stem of grapes surrounded by whipped cream and,

the male breast with psuedogynecomastia as the stem without the grapes but also surrounded by whipped cream. 

The stem are the breast ducts and the grapes are the glands producing milk. The whipped cream is the fat. 

Development of the male vs the female breast is dependent on the female having a greater ratio of estrogen production. This can happen in the male from various drugs including marijuana, anabolic steroids and alcohol. It is also found with liver disease.

You can feel the difference between the fat of a skin fold and the fibrous, nodular (grape stem or broccoli) nature of breast tissue. 

Both pseudogynecomastia and gynecomastia fat maybe reduced with liposuction and CoolSculpting. For most men with true gynecomastia and small areola without a breast fold, a tiny incision in the areola with removal of the breast ducts is generally satisfying. For large gynecomastia with large areola and a breast fold, a breast reduction surgery will be required to make the chest flat and male appearing.  

Please visit a Board Certified Plastic Surgeon for proper evaluation and consideration of all options. I hope this was helpful. All the best! 

Dean Kane has 2 Gynecomastia reduction before & afters:

Gynecomastia reduction before image performed by Dr. Dean KaneGynecomastia reduction after image performed by Dr. Dean KaneGynecomastia reduction before image performed by Dr. Dean KaneGynecomastia reduction after image performed by Dr. Dean Kane

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As you are probably aware, gynecomastia is an enlargement of the male breast gland. True gynecomastia is the presence of excess glandular breast tissue, and may be caused by hormonal changes or the side effects associated with certain medication. Pseudogynecomastia involves excess fatty chest tissue and is often associated with obesity.

The only way to know whether you have gynecomastia or pseudogynecomastia is to book an appointment with a doctor, who will perform a physical examination and/or an ultrasound to make a diagnosis.

It is possible to carry out a self-evaluation at home, but please note that this cannot be considered a reliable diagnosis. To do so, simply pinch the excess breast tissue — if it feels firmer than the surrounding fatty tissue, there’s a good chance that you may have true gynecomastia. On the other hand, if the breast tissue feels soft, you may have pseudogynecomastia.

I suggest not getting too hung up on the definition as treatment options for both gynecomastia and pseudogynecomastia are more or less the same. Your doctor will probably recommend a combination of liposuction and glandular excision to remove excess fat and reshape your chest. Be sure to speak with a board-certified plastic surgeon who has extensive experience in treating gynecomastia.

Before seeking surgery, I recommend losing weight through diet and exercise, and seeing what effect this has on your chest. Even if it doesn’t give you the results you want, it will provide you with a better foundation for receiving surgery.

Many patients come into our clinic worried about “man boobs”. A frequent secondary concern is whether or not they have “true gynecomastia”, which is actual breast tissue growth, or just excess fat deposits around the chest area.

The reality is that all excess tissue around the male breast contains some combination of fat and breast tissue.

From a plastic surgery perspective, whether or not male breasts are enlarged because of chest fat or glandular tissue development has little bearing on the procedure we use to treat the problem.

Both gynecomastia treatment and pseudogynecomastia treatment are accomplished via gynecomastia surgery and liposuction. The surgical approach to male breast reduction is to make a circumareolar incision to remove the fat cells and any excess glandular development that has occurred.

In the event your condition is not the result of glandular growth but simply a case of excess fat, then non-invasive therapies like CoolSculpting can also be an option. If you're overweight, starting a weight loss program should be beneficial.

I suggest making an appointment with a plastic surgeon to determine which treatment options are right for you.

If there's only fat, it's pseudo.  Of there's gland tissue , which is much firmer, then it's gynecomastia. The treatment is the same. You can always visit a doctor instead of trying to self diagnose  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  

If you have any excess tissue on your chest which you find undesirable, then it should be considered gynecomastia.  Virtually 100% of men with excess tissue have a combination of breast and fat tissue -- in varying ratios.  And, most surgeons will agree that the treatment is exactly the same.

Some guys want to try to differentiate in the hope that "pseudo-gynecomastia" is just fat and that it can be dieted and exercised away.  Sorry, that is not true.

Perhaps you might want to read my discussion about this on    ( )

Elliot W. Jacobs, MD, FACS

New York City

Elliot Jacobs has 3 Gynecomastia reduction before & afters:

Gynecomastia reduction before image performed by Dr. Elliot Jacobs Gynecomastia reduction after image performed by Dr. Elliot Jacobs Gynecomastia reduction before image performed by Dr. Elliot Jacobs Gynecomastia reduction after image performed by Dr. Elliot Jacobs Gynecomastia reduction before image performed by Dr. Elliot Jacobs Gynecomastia reduction after image performed by Dr. Elliot Jacobs

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