Dr Bermant - Q for u.

[vishal_chauhan]

Hello Dr. B,

In one of the posts, you mentioned that "Gland is below the nipple area and applying pinching pressure can tether the nipple pulling it in" . i didnt quite catch that. cud u pls explin what that means.

Lets say a person with gyno is out in the cold. if the nipple shrinks due to the cold, does that mean the nipple has tethered? does pinching and staying in cold put the same effect on the nipple? pls let me know if im thinking right.

thank u Dr. B!!

[vishal_chauhan]

Forgot to ask. Does the tethering/shrinking nipple in the cold  suggest a perosn had gyno gland under the npple?

[bogieman]

that was certainly true with my gyne- pinch push it down and it shrinks up for just a little while- get a chill and as long as y ou have the chill the gland looks good- warm up and it goes back to where it was

[vishal_chauhan]

is this behavior observed in people without gyno also? does this mean the gyno gland exists and needs to be excised??

[DrBermant]

Hello Dr. B,

In one of the posts, you mentioned that "Gland is below the nipple area and applying pinching pressure can tether the nipple pulling it in" . i didnt quite catch that. cud u pls explin what that means.

Lets say a person with gyno is out in the cold. if the nipple shrinks due to the cold, does that mean the nipple has tethered? does pinching and staying in cold put the same effect on the nipple? pls let me know if im thinking right.

thank u Dr. B!!

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.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

Breast gland connects to the nipple, the central structure of the areola.  The anatomy is set up so that milk can be delivered to the nipple from gland, through ducts, to the skin.  This is true for all mammals, both sexes included.  In women hormones make breasts big enough to feed babies.  Some gland exists in all men.  Just because it is there does not mean it must be removed.

When an inbalance of hormones exist in men, the glands can enlarge.

The anatomy of the gland to ducts to nipple can be used to demonstrate gland sometimes. When pushing the mass behind the nipples back, the tethering or connections to the skin, will sometimes pull the nipple skin back also.

This is different from the thin muscle under the areola skin that can flatten tissue when stimulated. Unfortunately it is impractical to keep stimulating these muscles.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture