How do I feel for gland?

[hatemymoobs]

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

[thetodd]

Ideally, go to a surgeon/doc

lie down on your bed, take your thumb index feel and feel behind the nipple this should be the gland. Everyone had gland there it just depends on the size some people claim to feel golf ball lumps behind but in my experience i couldnt feel a thing even though i had 30g's of gland removed

you need to get a medical proffesional to have a look, all of the docs i went to felt breast tissue

[hatemymoobs]

Thanks.
When I do this under the nipple feels vacant. Like nothing is there. Just like if I push in the nipple, surrounding it feels like there is tissue, but behind the nipple feels hollow if that makes sense.

My GP felt around during a physical and said it's not gyne, but it sure looks like it to me!

I'll be seeing an endo and a couple PS's as well, hopefully soon.
In the mean time- any explanation to this hollow feeling immediately under the nipple? The hollow feeling is about the size of the nipple...
Anyone, doctors especially, any guess as to what this is?

[puffycurse]

Dude! I know what you mean. Hollow spot right under the nipple but the surrounding area has firm tissue, right? For me, it feels like there is hard gland above my nipple and nothing under it. I've been wondering that too. I'm guessing the gland above makes a small pocket below. The weird thing is though; when I try to feel for a hard gland, all I can feel is a very small, dime sized gland; but my nipples are stilled puffed and the surrounding area raised with a random hole in the middle. I would like to know this too!  

[Dr. Elliot Jacobs]

For a lay person to try to discern gland from fat is a fool's errand.  Even surgeons can't be totally sure when they examine a chest.  Many times, gland can be soft and fat can feel hard -- and vice versa.

What is most important is if there is excessive tissue on the chest.  This can be determined by tensing the underlying pec muscle and then pinching the tissue starting from the collar bone and extending down to the lower ribs.  Gyne will manifest as excessive tissue (both gland and fat) under the areolas -- whereas the pinch under the collarbone will be relatively thin (only skin and fat).

Best advice:  if you think you have gyne, then have it checked out by a surgeon for verification. 

Dr Jacobs

[jojo82]

Breast tissue certainly does have a different consistency than adipose tissue. The problem is that breast tissue is often dispersed into the fat tissue, making it difficult to tell what you're feeling. In some men, including me, it's simple to tell where the gland/breast tissue is. It will feel "rubbery" and will have a markedly different texture than fat tissue. It will be mostly located right behind or around the areola.

But it's all a distinction without a difference at the end of the day. If it's causing you uncomfortable contour issues, it doesn't matter if it's breast, adipose, or scar tissue. First, exercise and get down to your target weight if you aren't already. Also see your primary care doctor to make sure there isn't an underlying condition causing your gynecomastia (liver failure, androgen imbalance, cancer, etc). That should be your first stop- not a surgeon.

[DrBermant]

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#msg2181

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 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.

[hatemymoobs]

Thanks a bunch for your replies.

My concern is that since the gland / breast tissue (vs fat) can't be felt very distinguishably- that a surgeon may say I need lipo-only and set me up for needing a revision, which I can't do.

I feel pretty confident there is some firm breast tissue in there- as I put one finger firmly around the nipple area, and with my other hand move the surrounding tissue around, I can feel with my finger a line, like a line of where the tissue ends. I think I've found where it ends above the nipple. The left side is slightly larger then my right- and when feeling around it seems that I can confirm that. But the way my GP felt for gynecomastia is different than how I did. He was kind of pinching around which when I do that it feels like fat.
When I point my finger onto a spot and move the tissue around with my other hand it feels more like a single mass of tissue rather than a bunch of fat cells.

Does this make sense?

And if this is the case it sounds like I will definitely need a doctor who will do an excision rather than just lipo.

Any feedback on this appreciated.

[jojo82]

Thanks a bunch for your replies.

My concern is that since the gland / breast tissue (vs fat) can't be felt very distinguishably- that a surgeon may say I need lipo-only and set me up for needing a revision, which I can't do.

I feel pretty confident there is some firm breast tissue in there- as I put one finger firmly around the nipple area, and with my other hand move the surrounding tissue around, I can feel with my finger a line, like a line of where the tissue ends. I think I've found where it ends above the nipple. The left side is slightly larger then my right- and when feeling around it seems that I can confirm that. But the way my GP felt for gynecomastia is different than how I did. He was kind of pinching around which when I do that it feels like fat.
When I point my finger onto a spot and move the tissue around with my other hand it feels more like a single mass of tissue rather than a bunch of fat cells.

Does this make sense?

And if this is the case it sounds like I will definitely need a doctor who will do an excision rather than just lipo.

Any feedback on this appreciated.

If you are a healthy weight and suffer from gynecomastia, you will most likely need excision. Lipo is not very effective at disintegrating breast tissue.

[Dr. Elliot Jacobs]

The object of gyne surgery is to obtain a smooth, flat, even and contoured chest with an "even pinch" of tissue from the collar bone down to the lower ribs.  At least, that is my operative plan when doing surgery.  In order to achieve this, either lipo alone or lipo with excision would be used.

Any surgeon worth his salt should not decide, prior to surgery, what specific method will be used.  Rather,  surgeons doing gyne surgery should be sufficiently flexible and capable so that if lipo alone does not work completely, then excision is done without hesitation.  If you speak to a surgeon and he/she is unwilling to be flexible, then I would recommend you consider another surgeon.

Dr Jacobs

[hatemymoobs]

The object of gyne surgery is to obtain a smooth, flat, even and contoured chest with an "even pinch" of tissue from the collar bone down to the lower ribs.  At least, that is my operative plan when doing surgery.  In order to achieve this, either lipo alone or lipo with excision would be used.

Any surgeon worth his salt should not decide, prior to surgery, what specific method will be used.  Rather,  surgeons doing gyne surgery should be sufficiently flexible and capable so that if lipo alone does not work completely, then excision is done without hesitation.  If you speak to a surgeon and he/she is unwilling to be flexible, then I would recommend you consider another surgeon.

Dr Jacobs

Dr Jacobs thank you very much for your reply. That is exactly what I'm hoping for in a surgeon. To be able to, in mid surgery, decide "this lipo isn't working" and go for excision if he feels that is necessary. I suppose I'll go to surgeons over and over until I find one that says he/she will know more and do what he/she feels will work best during the procedure- rather than mapping it out 100% before hand and not having any ability to "improvise" if needed.

I cannot feel a definitive gland, but rubbery tissue I think I can. I think I'd feel more confident with results with an excision because the Dr can SEE exactly what needs to come out.

 

[hatemymoobs]

If you are a healthy weight and suffer from gynecomastia, you will most likely need excision. Lipo is not very effective at disintegrating breast tissue.

I am a healthy BMI of 23 (high end of normal) but my midsection is fatty. My arms legs face and neck all look like I'm of thin build, but the midsection stores most of the fat- which is why I'll be talking to the PS about trying to even out my fat deposits (lipo around the waist a bit) while also building muscle around my arms and shoulders, and legs.

[jojo82]

The object of gyne surgery is to obtain a smooth, flat, even and contoured chest with an "even pinch" of tissue from the collar bone down to the lower ribs.  At least, that is my operative plan when doing surgery.  In order to achieve this, either lipo alone or lipo with excision would be used.

Any surgeon worth his salt should not decide, prior to surgery, what specific method will be used.  Rather,  surgeons doing gyne surgery should be sufficiently flexible and capable so that if lipo alone does not work completely, then excision is done without hesitation.  If you speak to a surgeon and he/she is unwilling to be flexible, then I would recommend you consider another surgeon.

Dr Jacobs

Dr Jacobs thank you very much for your reply. That is exactly what I'm hoping for in a surgeon. To be able to, in mid surgery, decide "this lipo isn't working" and go for excision if he feels that is necessary. I suppose I'll go to surgeons over and over until I find one that says he/she will know more and do what he/she feels will work best during the procedure- rather than mapping it out 100% before hand and not having any ability to "improvise" if needed.

I cannot feel a definitive gland, but rubbery tissue I think I can. I think I'd feel more confident with results with an excision because the Dr can SEE exactly what needs to come out.

 

It's imperative that you are comfortable with your surgeon and it doesn't sound like you are. Lipo issues aside, I suggest that you seek advice from other surgeons in your area.

[DrBermant]

Thanks a bunch for your replies.

My concern is that since the gland / breast tissue (vs fat) can't be felt very distinguishably- that a surgeon may say I need lipo-only and set me up for needing a revision, which I can't do.

I feel pretty confident there is some firm breast tissue in there- as I put one finger firmly around the nipple area, and with my other hand move the surrounding tissue around, I can feel with my finger a line, like a line of where the tissue ends. I think I've found where it ends above the nipple. The left side is slightly larger then my right- and when feeling around it seems that I can confirm that. But the way my GP felt for gynecomastia is different than how I did. He was kind of pinching around which when I do that it feels like fat.
When I point my finger onto a spot and move the tissue around with my other hand it feels more like a single mass of tissue rather than a bunch of fat cells.

Does this make sense?

And if this is the case it sounds like I will definitely need a doctor who will do an excision rather than just lipo.

Any feedback on this appreciated.

In looking for a surgeon, check out the quality of their work. Many years ago I evolve my Dynamic Technique to target gland first and then manage what I found during surgery. This came about with a more critical look at documentation of just what created what result. Looking at how tissues move after surgery is key. Although I may have one of the largest revision gynecomastia surgery practices, it is quite rare to revise on of my own cases. I never understood the method of doing surgery and then coming back for a revision if the first one did not work. That does not apply to a two stage process like a long nipple reduction following contouring tissue under the nipple. If there is a loose skin component, that is a separate issue since the scar is such a compromise. That makes a valid question, how many of the cases shown from a doctors' examples how many needed more than one operation to get there?

I have seen just too many disasters from those advocating liposuction first option. I finally started publishing from a collection of over 500 requests for help after other surgeons' liposuction that I reviewed from just the past few years. There were so many, that the project had become unmanageable so I broke it down to by location and just put up some of those examples. Common among the complaints is that the surgeons did not show many before and after pictures, and that there were limited views among what was shown. I have published examples of what I found during revisions of such cases and an explanation why I prefer to go after the gland first and then contour remaining tissues. When suctioned first, the cannula gets out the fat, not the gland digging a home for the gland in the fat. The problem is that the remaining gland does not compress like fat. Flex the muscles and the nipple sticks out. That is why checking for such issues should be part of understanding if a result is working.

Any doctor who claims that liposuction alone will contour just fine should be able to demonstrate such claims with flexing views, arms up overhead, and preferably movies which are even more critical in demonstrating what tissues look like in real life. When I am seeing unhappy patients from elsewhere, I am not seeing possible happy ones where the technique worked. Why would they come to me? Yet, the sheer volume of unhappy patients who have asked for my help plus what I have found during revision surgery would make me more than curious why, if a technique works, demonstrate it with more critical views for all to see?

So instead of listening to words, explanation and hand waving, why not go to evaluate the actual results. Even better published on a web site so they can be critically looked at in a relaxed setting and not rushed? By the time you get to that doctor's office, the details should just be a reinforcement, not a discovery process of what that person might, or might not be offering.

Why restrict yourself to what is close to you? That is a real limitation of options, unless you are fortunate and have a real master nearby.

Hope this helps,

Michael Bermant, M.D.

[hatemymoobs]

Dr Bermant - thank you for the reply.
I am not in a financial position nor do I have the time for me to travel to see a doctor. Luckily living in Dallas there are several doctors to choose from- and I feel confident there are a handful who are worthy of using their scalpel on me.

So in your methods- you do excision of tissue and gland first, and then do liposuction afterward? Does this mean every patient will likely have a areola incision? I am open to that kind of operation just whatever gets it done right the first time.

@jojo- I haven't found a surgeon yet. I have been doing research and taking notes on doctors, prices, how many patients with gyne they typically see- etc. One doctor does a lot of gyne surgeries but had a special cutting cannula that I've heard mixed things about. In other words most of the time he does lipo only- but it's not an ordinary lipo, his cannula allegedly breaks up the tougher breast tissue and gets it out through a tiny incision. All sounds good, but I want to be sure I have no puffy nips afterward. I'd rather have a flat nipple and slightly fatty chest than what I have now- pointy nips with moderate amount of fat/tissue.

I'm definitely going to see an endo. Nutrition will play a large role in my goal to rid the moobs, along with gaining muscle around the shoulders and arms to make the chest appear smaller. But ultimately I have to see a surgeon, and a good one at that- to get rid of the moobs for good.