self test

[rupert20]

i am not able to go to a doctor to get an official diagnoses so I was wondering if I could self diagnose if I had pseudogynecomastia or gynecomastia. 

Is there test I can perform? I know I should trying to feel for "tissue" but I don't know what this feels like.

i read something online about lying on ur back and pinching your nipples and seeing if your fingers meet or something?

If, when I lie on my back and put my hands behind my head my chest becomes flat does that mean it is pseudogynecomastia? If it were real would it still poke out even if I stretched my arms back?

You get the idea of what I am getting at here.  Any tips to be able to tell is greatly appreciated.  My BMI is 24.8 so I am not overweight, but I am not skinny. 

[Dr. Elliot Jacobs]

I do not make distinctions between pseudogyne and gyne -- both represent an excessive and disproportionate amount of tissue on a man's chest.  And trying to distinguish between fat and gland by feeling the tissue is a fool's errand -- fat can feel soft or firm and the same with gland tissue -- even to my experienced fingers.  In fact, most tissue on a man's chest contains BOTH fat and gland tissue -- in varying ratios.

The best way to determine excess tissue is with what I call the "pinch test."  Pinch the skin and fat on your chest just below the collar bone while standing up.  And then continue pinching down your chest to the upper areas of the abdomen.  That pinch should be the same all the way down.  If the pinch thickens considerably as you descend, particularly around the nipple areas, then you have gyne.

Dr Jacobs

[rupert20]

thanks for the reply

Alright, so according to your pinch test I have gyne.  However, while you do not distinguish between "pseudo" and "true" gyne, how can I know if exercise will make it go away or if I need surgery?

Because, as I interpret it, if it is mostly fat then exercise will remove it, however if it is mostly gland then I am wasting my time.

I hear that exercising can make it worse? Is this true? Once again, i am not skinny, but I am not fat.  I am very average in weight, muscle definition, etc (save for my protruding nipples, and little extended fat in my lower gut...)

[DrBermant]

i am not able to go to a doctor to get an official diagnoses so I was wondering if I could self diagnose if I had pseudogynecomastia or gynecomastia. 

Is there test I can perform? I know I should trying to feel for "tissue" but I don't know what this feels like.

i read something online about lying on ur back and pinching your nipples and seeing if your fingers meet or something?

If, when I lie on my back and put my hands behind my head my chest becomes flat does that mean it is pseudogynecomastia? If it were real would it still poke out even if I stretched my arms back?

You get the idea of what I am getting at here.  Any tips to be able to tell is greatly appreciated.  My BMI is 24.8 so I am not overweight, but I am not skinny. 

"Fat or Gyno" is a frequent question here, but misses the point.  Gynecomastia is a contour problem.  All male mammals with have gland.  All fat men and women have big breasts. 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. Pseudogynecomastia is a bad term that 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 a contour 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 Photos can show a region that compresses differently.  Even clinical examination of the male chest such as a pinch test (that I have been talking about here on this forum for many years) can be difficult to differentiate gland vs. fat.

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.

BMI Calculator (Body Mass Index) may be a starting point. Unfortunately, BMI does not take into account bone, muscle mass, vs. fat.  Body Fat Analyzers can help define that issue.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia Male Breast Reduction

[rupert20]

alright, thanks for all the help. Surgery is pretty much out of the question at this point...so, from what I gather it is possibly gland and fat, so doing cardio, and working out will help to reduce the appearance?

[Dr. Elliot Jacobs]

The problem is that males put fat on their chest, abdomen and love handles first.  And these areas are the last to lose their fat.  Unfortunately, there are too many cases in which significant exercise has reduced a guy's weight but the extra tissue on their chest (albeit somewhat smaller) stubbornly persists.

Obviously, no harm in trying with diet and exercise.  But be aware that there may still be some residual tissue on your chest -- and at that point, and only if it bothers you, the only alternative would be surgery.

Dr Jacobs

[DrBermant]

alright, thanks for all the help. Surgery is pretty much out of the question at this point...so, from what I gather it is possibly gland and fat, so doing cardio, and working out will help to reduce the appearance?

Some questions tend to come up here in this forum quite frequently. Take a look at the date of this prior post:

Dieting and exercise can make a major change in the entire body including the chest.  Gland is not helped by weight loss.  Residual fat and gland can still cause distortions in the male chest profile. 

The problem is that we do not know how to target where weight comes off from or where it gets added to.  Men tend to add weight to their chest, abdominal region, and love handles.  It can be very difficult to lose weight from those regions. 

Surgery is sometimes an option, before weight loss.  Weight loss is the coarse tool while surgery is the fine one.  As a surgical sculptor, I prefer the coarse tool first, then the fine one second when possible.  I have many patients who lost weight after surgery.  Losing weight after surgery is a gamble.  If the breast area does not reduce with weight loss it can look as if the breasts have "regrown" while what actually happened is that less fat came from the chest than other areas.

Losing weight, having surgery, and then putting fat back on is also a gamble.  Men tend to put fat back on the breasts, abdomen, and love handle regions.  You may get away with it, but is rushing worth it?

Realistic expectations of what surgery offers is important to long term happiness.

Here is a later variation of the same question/answer showing an evolution of my efforts at public education here:

The problem is that Male Fat Pattern extends around the chest, under the arms, and around the back.  Plastic Surgery is not a good tool for a global fat problem.

I advise my patients to get to a weight / body fat percentage they are comfortable with before considering surgery.  A BMI Calculator does not differentiate between fat, muscle, and bone.  Body Fat Calculators can help with the fat percentage and are better at helping with the fat component.

For those with too much body fat, Weight Loss Before Gynecomastia Surgery can help with the fat, but not the gland.  However, you cannot pick where your fat comes from.

The biggest change I have noticed over the years, is that patients who lose weight tell me that they feel so much better about themselves. It often changes the front to a degree, but the sides and back can see a major benefit from getting the excess total body fat under control.

Plastic Surgery is not a good jump start tool for weight loss.  I have seen disasters from patients from other doctors with deformities from significant weight loss after their surgery.  Men tend to put fat on first in the belly and chest bands.  We tend to take of those areas last.  Early surgery and depending on weight loss to predictably change the body is a nasty gamble.  No Surgery Body Shaping Garments are a better temporizing choice.

As a surgical sculptor, I view weight loss as a coarse tool and my plastic surgery as a refinement tool.  I prefer to use the coarse tool first, and then my sculpture for refinement.

For those having compromise surgery before (or without) weight loss, try to check out before and after pictures from many different angles.  (You should carefully evaluate results with more than just one or 2 views for each patient, especially if those views change from patient to patient. Plastic Surgery is not an alternative to losing weight.  A fat person will still look like a fat person, just one with smaller breasts.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture

[jsboob]

 arent all males BORN with breast tissue? ( same as females are)
SHOULD there be NONE at all in order to be normal?

[Dr. Elliot Jacobs]

All men have rudimentary breast tissue directly beneath the nipple/areolar complex -- that is a normal condition.  Gynecomastia represents an excess amount of tissue on a male chest --be it breast tissue, fat or in the vast majority of cases, both types of tissue.

Dr Jacobs

[DrBermant]

arent all males BORN with breast tissue? ( same as females are)
SHOULD there be NONE at all in order to be normal?

All mammals, both male and female, have breast tissue. You can see the typical Anatomy of Gynecomastia here which will consist of gland, fat, and skin. Gynecomastia is a contour problem, a female like shape to the male breast. The deformity can be subtle as in Puffy Nipple Gynecomastia or much more profound.

Normal also should include that the tissue moves naturally, not scarred down nor deformed by firm scar nor residual deforming gland. That is why I evolved animation component of my before after surgery picture documentation.  Normal should also be seen with the areola muscle relaxed not tight from a cold room.

Video Documentation of Gynecomastia

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction