Does everyone with gynecomastia have enlarged and puffy nipples?

[CanadaCraig]

Hi Guys!!

I hope you're OK.

Someone I'm talking to on the net about gynecomastia said the following....

"In true gynecomastia the nipples become enlarged and protrude while in cases of just excessive adipose (fat) deposition the nipples remain pretty male-like."

Is that true?!

I ask because I have so-called 'man-boobs' but my nipples - although soft to the touch - certainly do not protrude. Does that mean that I do NOT have gynecomastia?!

Thank you,
Craig!!

[J03L]

That's not totally true. I have large breast, but my nipples are fine.

[cody sockeye]

I have puffy nips, but they aren't what I'd consider "enlarged".

[RyanMace]

An abnormal amount of breast tissue = gynecomastia

Just fat = pseudogynecomastia

[DrBermant]

Hi Guys!!

I hope you're OK.

Someone I'm talking to on the net about gynecomastia said the following....

"In true gynecomastia the nipples become enlarged and protrude while in cases of just excessive adipose (fat) deposition the nipples remain pretty male-like."

Is that true?!

I ask because I have so-called 'man-boobs' but my nipples - although soft to the touch - certainly do not protrude. Does that mean that I do NOT have gynecomastia?!

Thank you,
Craig!!

Unfortunately, it can be difficult to distinguish just what is causing the problem.  Gynecomastia male breasts can be fat, gland, or most commonly a combination of both.  Sometimes skin and sagging tissues can be a factor.  Pseudo Gynecomastia is supposed to be fat only gynecomastia.  The problem with that "classification" is that in almost every case of gynecomastia I have seen there is some component of gland.  This gland can be very small, but it is present almost all the time.  So do you have Pseudo gynecomastia when there is a 1%, 10%, 50%, or 90% deformity from fat?  Reality just does not work that way.

Defining the problem with photographs sometimes can help.  However, it is impossible to tell from photographs if the deformity is from fat or gland. The dynamic images, of my standard set of images can show a region that compresses differently.  Even clinical examination differentiation can be difficult.

Fat tends to be soft, gland tends to be firm.  Fingers of gland often dissect between fingers of fat.  Look at this drawing and move your mouse over the arrows.  However, gland can be soft and fat firm confusing the picture.  Gland tends to be located under the nipple and pinching pressure can sometimes tether to the nipple pulling it in.

Men with excessive fat do tend to have certain contour issues.  Check out this link about Sumo Wrestlers.  Men tend to carry excessive weight in their chest and stomach.

Losing weight first, to something you are comfortable with and can maintain is typically a much better option.  Weight loss is a coarse tool.  Unfortunately, you cannot pick where weight comes from - nor can you pick where weight goes back on to.  Gland that contributes to the breast shape is not helped with weight loss.  Fingers of fat in the gland can become smaller, but the contour problem from gland does not go away.  After losing weight plastic surgery can help with localized fat, gland, and extra skin.  After surgery remaining fat cells can put on more weight.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture