Mammary disk

[jdr]

I am 57 years old.  I have had minor gynecomastia since puberty.  It hasn't caused me any problems since I finished school.  About 18 months ago my primary care doctor, tested my Testosterone and found low T (<220).  He started me on Androgel 2.5mg).  Within a few months, my breasts started becoming very sensitive and seemed to be growing.  I was referred to an endo.  By now many months had passed.  On examination, the endo found that the mammary disks were approximately 2.5 cm.  He increased the Androgel to 3.75mg.  Six months later. on a recent visit, the mammary disks measured 5cm.

My question is for a point of reference.  The doctor wasn't clear with me.  How big is big?  If 2.5cm was big, then what is 5cm?  How big might they become?  I have not found a reference to where 5cm would fall on a standard deviation of gynecomastia cases. The only point of reference I have is that I now fit very nicely in a 40B bra. I would appreciate any information you could provide.  Thanks,

jdr

[DrBermant]

I am 57 years old.  I have had minor gynecomastia since puberty.  It hasn't caused me any problems since I finished school.  About 18 months ago my primary care doctor, tested my Testosterone and found low T (<220).  He started me on Androgel 2.5mg).  Within a few months, my breasts started becoming very sensitive and seemed to be growing.  I was referred to an endo.  By now many months had passed.  On examination, the endo found that the mammary disks were approximately 2.5 cm.  He increased the Androgel to 3.75mg.  Six months later. on a recent visit, the mammary disks measured 5cm.

My question is for a point of reference.  The doctor wasn't clear with me.  How big is big?  If 2.5cm was big, then what is 5cm?  How big might they become?  I have not found a reference to where 5cm would fall on a standard deviation of gynecomastia cases. The only point of reference I have is that I now fit very nicely in a 40B bra. I would appreciate any information you could provide.  Thanks,

jdr

How big before gland becomes a contour problem varies by body fat, body build and many other factors. For an extremely lean competition body builder even a tiny gland can disfigure the clean cut look of the pectoral muscles. For a morbidly obese man, 5 cm glands can be lost in all of the extra body fat.

The main issue is why are the glands still growing?  Why is the Testosterone low?  Finding the actual cause to stabilize some problems can be quite difficult. Tracing the cause can even more difficult while on Testosterone. Surgery will not prevent recurrence. That is why getting a problem stabilized first before considering surgery is so critical. You can find much more extensive discussions about "gynecomastia recurrence" here on this forum using the search function showing examples of recurrences I have seen during my practice. Many of these examples had failed evaluations by other endocrinologists before seeing a another more experienced Endocrinologist for their diagnosis. Like surgeons, not all Endocrinologists have the same skills nor passions.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[jdr]

Dr Bermant,
  Thank you for your reply.  I am not that concerned about breast profile appearance.  I have a body mass index of about 28, so it hides satisfactorly.  I am not interested in surgery.  My interest is what is a more medically related question concerning the common range for mammary disk growth with gynecomastia.  I am currently at 5cm.  What range do you typically see in your patients?  Thanks again.

jdr

[DrBermant]

Dr Bermant,
  Thank you for your reply.  I am not that concerned about breast profile appearance.  I have a body mass index of about 28, so it hides satisfactorly.  I am not interested in surgery.  My interest is what is a more medically related question concerning the common range for mammary disk growth with gynecomastia.  I am currently at 5cm.  What range do you typically see in your patients?  Thanks again.

jdr

What is felt mechanically can be firm fat or gland. By clinical exam you just cannot tell. Although gland tends to be firm and fat soft, fat can be firm and gland soft. I have posted here before resources about sizes of glands I have removed during surgery:

https://www.gynecomastia.org/smf/index.php?topic=14829.msg103655#msg103655

Unfortunately my Gallery of Glands removed does not have a ruler for size, and looking at the gland is like looking at a jelly fish out of water. You would need to understand the Anatomy of Gynecomastia to understand that fingers of gland run through fingers of fat. This makes edge determination during examination of the male chest like measuring the extent of that jelly fish in water. You can also see such "size" concept vagueness with the male mammograms pictures. Those resources are further discussed here in this post:

https://www.gynecomastia.org/smf/index.php?topic=21543.msg145966;topicseen#msg145966

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[Dr. Elliot Jacobs]

Totally agree with Dr Bermant.

There is no absolute way to measure the size of breast tissue by feel alone -- for the feel can be deceptive.  Also, there is no discrete "edge" to the tissues -- the fat and breast tissues merge with one another -- just like interlaced fingers.

As surgeons, we artistically remove sufficient tissues to achieve a nice looking chest.  Those tissues have both fat and breast tissue as components.

Dr Jacobs

[jdr]

Drs Bermant and Jacobs,

Thanks,  I think I understand the situation better now.  It also explains why I wasn't able to find any "hard" information in my research.  I appreciate your time.

jdr