When I press my finger into my nipple it feels like there is nothing behind there but some very soft tissue.
It almost feels like there is breast tissue in my chest, but a hole in that tissue right behind my nipple... Does this make sense?
The area around the nipple seems squishy but slightly firm (I assume this is breast tissue) and immediately under my nipple it feels... empty. Like there is literally a hole. It's like this on both sides of my chest.
I don't know if this means there is no gland, the gland is small, or if I don't know what to feel for... but I'm just confused.
Can any doctors chime in on what I am feeling? If further clarification is needed, just let me know- it's hard to explain how something feels through a message with no image or anything....
Thnx
Some questions keep getting asked here in this forum. It is nice to see others pick up on my campaigns of public education. Check the date of this forum post.
https://www.gynecomastia.org/smf/index.php?topic=197.msg2181;topicseen#msg2181Unfortunately, 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 muscles can be a factor.
Fat tends to be soft, gland tends to be firm. Fingers of gland often dissect between fingers of fat. 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.
From that long ago, my answers have evolved. I now say:
I had a bunch of lumps on teh left and right size that felt anywhere between pea to grape sized. Both sides felt the same to me but after surgery the doc told me that he took way more gland out on teh left than on the right. Palpation isn't gonna give you an exact idea of how much gland is in there pre-op.
Unfortunately feeling alone is just not that accurate. Although gland tends to be firm and fat soft, gland can be soft and fat firm. Scar tissue can be just as firm or more firm that gland. Scar tissue can also stick structures together, adhesion. The goal for this surgical sculpture should be how it looks especially on movement, playing sports, swimming, and living life. Perfect surgery, something I aspire to, has no visible scars or distortions that can be felt, but that is just not realistic.
The fact is that with all of the decades I have been doing this and working with up to 8 gynecomastia patients a day, I know I cannot accurately distinguish gland from fat on clinical exam. This is the same for any mammal breast, male and female. It goes to the nature of the anatomy and the limitations of what finger sensation reveals. I have been trying to educate to pubic about this for many years before the posts I quoted here. To further clarify with visual graphics (links no longer permitted) I made Anatomy of Gynecomastia drawings demonstrating how fingers of gland go through fingers of fat.
I have tried to commit myself for each of my patients with my map on their chest before surgery of where I thought the fat content began and where the gland content was. You can see many of these examples on my site. The pictures of the gland on the chest after surgery is as close as I can demonstrate what I found. That picture at the end of surgery is somewhat artificial. It is like taking a picture of a jellyfish out of water. These fingers of gland are not in their natural state floating in the fat, but it is as close as I can get without unnecessary waste of money and radiation for a CAT scan or MRI. You can get to this detail by looking at the specific patient or by going to the Gland Gallery and then going to the individual patient.
Inside the patient it becomes obvious. The gland is white just like scar tissue or connective tissue. Fat is yellow. It becomes obvious to visual recognition and also by feeling inside. My 1.6cm incision size is determined by my small finger, that is the smallest incision that I can get my small size hands into. Firm tissues inside are what show up as a puffy nipple complication. Compressibility is the factor as muscles expand against the skin and structures in between. Remove these firm structures (gland and scar when a factor) and there is less chance of see a contour compression differential. No this is not cancer and you do not
have to get the gland out. But it is sure nice to play a game of basketball or lift weights and not see a puffy nipple complication of contour deformity after surgery. What I have found is that what seems like firm fat is just fat that has sheets of fingers of gland firming up that complex. You can see these filmy planes on some mammograms. So my finger finds the firm structure and I directly and visually remove that film and voila, the remaining fat is no longer firm.
That is how the Dynamic Technique evolved. It started out with stabilizing the problem before surgery, targeting gland first, and then dealing with contouring remaining tissues drawing from an artist's pallet of surgical tools for the contouring.
Back to you original question, breast tissue both in women and men will have gland, fat, and skin making up the contour. We do not talk of gland of female breast making up the contour. The contour is the combination of fat, gland, and skin. So it goes for the male chest. When elements contribute to contour that does not say male, then it is gynecomastia even the subtle puffy nipple variation.
Hope this helps,
Michael Bermant, M.D.