gynecomastia question

[gregr]

Just wanted to ask is gynecomastia appear hard on top of areola and go down side of breast. Please let me know. Thanks Gregr

[DrBermant]

Just wanted to ask is gynecomastia appear hard on top of areola and go down side of breast. Please let me know. Thanks Gregr

The gland tends to attach to the nipple just under the areola but can extend deep in the fat towards the fascia layer over the muscle.  I have seen many cases where the gland can extend well around the pectoral chest muscle towards the armpit.

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.

Hope this helps,

Michael Bermant, MD
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