Breast tissue

[Salsoul]

As expected when I went to see my GP he focused on me being overweight and that I just have excess fat.
I have had a blood test to check my hormone balance but I can't ignore the bounce I get when I walk at pace or run, yes I can feel the fat but when I get the bounce I can definitely feel something denser in side, like golf ball size, so for me it feels more than just fat.
I have tried examining my breasts and there is soft fat material where my pecs should be.
However as I approach my nipple area, I do feel denser harder material, as I understand the normal diameter on a man is about 2cm, but on me the diameter of this harder material is more like 6cm.
Is this going to be the glands and excess breast tissue?
I have attached my original photo and also one of each breast showing where I hit denser material.
Again any advice would be appreciated as convincing my GP that there is more to my breasts that excess fat is going to be challenging.
Thanks again.

[Dr. Elliot Jacobs]

Obviously, the first thought for treatment should be weight loss to a better, more comfortable and stable weight.  However, even then, most guys who have been overweight will state that their breasts never regress entirely and that they are still left with excess tissues on their chest which are not commensurate with the rest of their body.  Reason?  When overweight, your breasts are a combination of fat and breast tissue.  Breast tissue does not respond to weight loss -- it remains.  Hence, if you lose weight, the fat component of your breasts will diminish but the breast tissue remains.  Bottom line: you can never fully get rid of excess breast tissues by diet alone.  Surgery remains the sole treatment for this remaining tissue.  It can target and remove the remaining tissues to provide a trim and muscular-appearing chest.

Feeling for "breast tissue" can be misleading -- breast tissue can sometimes feel soft and fat tissues can feel firm.  What is important is the fact that there is excess tissue overlying your chest muscle -- and no amount of diet or exercise will fully remove this.  

The aim of properly performed gynecomastia surgery is to provide a thin and uniform pinch of skin and fat from the collarbone down to the fold beneath the pec muscle.  Ideally, once surgery is done, you will not be able to grab any substantial amount of tissue under the nipples.

Many GP's simply do not understand this concept -- and unfortunately, trying to convince them otherwise is often futile.  To carry this further, most insurance companies will have a lengthy list of pre-requisites in order to fulfill requirements for gynecomastia surgery coverage -- most of which guys simply cannot comply with.  Thus, most gynecomastia submissions to insurance companies are deemed "cosmetic" and therefore not covered.

Dr Jacobs

[Litlriki]

Dr. Jacobs' thoughtful response addresses your question about how to convince your GP that you have gynecomastia and it's a problem requiring more than just diet, but I may have missed the point of what you're trying to do, unless it was to get him to refer you for surgery.  As Dr. Jacobs indicates, insurance rarely covers the surgery, and the reimbursement when they do cover it is barely worth the effort of submitting the bill, at least in Massachusetts, where we can't bill the remainder of the procedure cost to the patient. We have stopped making the effort except in very rare cases, as it's a complete waste of time. So, unfortunately, while the procedure is "reconstructive" in nature for many men, insurance companies see it only as cosmetic. 

If you are unhappy with your chest and diet isn't enough to fix it, you should consult with a plastic surgeon with gynecomastia expertise--with or without a referral from your GP--so you'll at least have a better sense of your options.