I need insight into my gyno situation...

[AREM]

Hello,

After creeping around here for a few months I've become frustrated enough that I need advice. I'm 21 years old, 5 foot 10 and 147 pounds. I'm by no means fat, I eat healthy, and go to the gym three times a week. Ever since i was 12, i've had issues with gynecomastia. Like most of us here, I was told that it would go away after puberty and that it would be reevaluated when i was passed puberty. At that point in time you could feel the noticeably hard gland underneath the nipple, however, as the years progressed that hard gland disappeared (the appearance of my chest didn't change though).

anyways, long and the short is that when I was 18, i visited the doctor again who told me that there's still a chance to lose them through diet and exercise. Three years later, after that didn't happen i went to visit him again, this time he took blood tests, checked hormone levels, and sent me for a test to see what in fact was making my nipples puff out and my chest big. When the results came in, it turns out there is supposedly no gland underneath and it appears to just be 'tissue'. He didn't seem to know anything really about the situation and had absolutely no reasons as to why my nipples are extremely puffy and my chest sticks out.

To me it seems like pseudogynecomastia, but then again exercise hasn't done anything... I'm rather confused as to what it is at this point, and what action i should take. Perhaps visiting another doctor? Has anyone here ever seen a reduction in pseudo-gyno through exercise? Googling only seems to yield a bunch of fake products claiming to get rid of man boobs... any insight would be appreciated.

Thanks

[Dr. Cruise]

Hello AREM,
Your situation is very common. Keep in mind gynecomastia is never completely solid breast tissue. It is rarely completely fatty. It is often a combination. I have referred to this as Classic Gynecomastia as it is the most common version.
This is outlined in great detail.

No matter what the ratio of Breast Tissue to Fat, adequate treatment typically requires excision of the breast tissue - often with some degree of liposuction depending on your situation. There are rare occasions with True Fatty Gynecomastia (often referred to as pseudo-gynecomastia) where liposuction alone can suffice but this is rare. I routinely have patients who I revise after failed attempts of liposuction alone.

My advise is to go to a plastic surgeon who specializes in gynecomastia surgery in your area if there is one available. The problem is there are not that many and you may have to travel. It would be worth your while to look into some of the surgeons who post here.

I hope this helps.

[DrBermant]

Hello,

After creeping around here for a few months I've become frustrated enough that I need advice. I'm 21 years old, 5 foot 10 and 147 pounds. I'm by no means fat, I eat healthy, and go to the gym three times a week. Ever since i was 12, i've had issues with gynecomastia. Like most of us here, I was told that it would go away after puberty and that it would be reevaluated when i was passed puberty. At that point in time you could feel the noticeably hard gland underneath the nipple, however, as the years progressed that hard gland disappeared (the appearance of my chest didn't change though).

anyways, long and the short is that when I was 18, i visited the doctor again who told me that there's still a chance to lose them through diet and exercise. Three years later, after that didn't happen i went to visit him again, this time he took blood tests, checked hormone levels, and sent me for a test to see what in fact was making my nipples puff out and my chest big. When the results came in, it turns out there is supposedly no gland underneath and it appears to just be 'tissue'. He didn't seem to know anything really about the situation and had absolutely no reasons as to why my nipples are extremely puffy and my chest sticks out.

To me it seems like pseudogynecomastia, but then again exercise hasn't done anything... I'm rather confused as to what it is at this point, and what action i should take. Perhaps visiting another doctor? Has anyone here ever seen a reduction in pseudo-gyno through exercise? Googling only seems to yield a bunch of fake products claiming to get rid of man boobs... any insight would be appreciated.

Thanks

Yes, I have seen fat only gynecomastia reduce with weight loss. At your height and weight your Body Mass Calculation is 21.1, well within the normal range. Men tend to put fat first on the breast and belly regions that is just normal for Male Body Fat Distribution. With weight loss unfortunately, you cannot pick where the fat comes from. Weight loss will also not help with a gland component. While some use the term Pseudogynecomastia for "fat only" cases, this is a poor term since does that mean 100%, 90%, 80%. A woman's breast has a major fat component, but we do not call that breast a pseudo-breast.

Puffy Nipple Anatomy consists of gland, fat, and skin. The proportions vary, but all male mammals will have a gland component. A clinical examination of the male chest is not reliable in determining fat vs. gland. While fat tends to be soft and gland firm, fat can be firm and gland soft.  While you could get a Male Mammogram Xray to determine what is fat vs. gland, the cost and unnecessary radiation is not worth it unless there is something that shows up during a clinical examination that warrants such testing.

That is why I evolved my Dynamic Technique for male chest sculpture many years ago. Letting what I find during surgery determine what I will do. Yes, I do find fat only cases with trivial gland that I only liposuction. But that is quite unusual since gland often is a significant contributing factor.  When there is gland, I prefer to target the gland first and then use the remaining fat to permit me to remove more gland yet leave a flat chest.

Not all doctors know what testing should be ordered. If there are Red Flags, then further testing may be appropriate. I prefer to have an experienced Endocrinologist get involved if the gynecomastia is not stable.  Such issues are best explored with an experienced gynecomastia surgeon, one who is not quick to offer only surgery as the solution when other factors are in play that should be stabilized first.

Hope this helps,

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

[Dr. Elliot Jacobs]

Agree with Dr. Cruise.

If you are healthy and in excellent physical shape, then what you have on your chest is probably a combination of stubborn fat and breast tissue.  You have given it sufficient time to resolve by itself and no further dieting or exercise will make it disappear.

Would suggest you consult with several experienced gyne surgeons for their opinion.

Dr Jacobs