Proper way to diagnose gyne and do I have it based on photos?

[gyno_bruh]

So i went to see my PCP and she did a basic breast examination with the flat palm of her hand pushing into my chest all around to feel for what she was looking for. I told her that i have pain behind my nipples and they are sensitive. She said she found nothing, but decided to prescribe a breast mammogram and breast ultrasound. both of these procedures cost alot of money and my insurance does not cover these until i reach my deductible. I also am not sure if they are really needed? i think my PCP thinks i may have breast cancer. she did not seem to even consider gynecomastia. so i made an appointment for a free consultation with a local plastic surgeon to see his opinion.  Is there a cheaper way for the plastic surgeon to determine if I do have gynecomastia or not? i thought he can just feel behind the nipple for hard or soft tissue, to determine if its fat or actual breast tissue growth. this would save me money and time. Do you think i should see the plastic surgeon first and that he should be able to diagnose me without the requirement of those expensive tests? i really do not think that my PCP considered gynecomastia or was even aware of how to test for it? as in she did not bother to pinch behind the nipple area to see if theres a difference in feel. there is clearly a difference in the size of my breasts around the nipple area as well as pain, which i described.

[Litlriki]

Based on your description of symptoms and your photos, it appears that you have gynecomastia.  Ultrasounds and mammograms are generally of little to no value in diagnosing gynecomastia, and these tests have value only if there is concern over breast cancer.  If your PCP is worried about that, you may have to start reaching your deductible.  If the diagnosis is not in question, but the cause is, the testing should focus on determining the cause, so that it can be addressed prior to correcting the cosmetic deformity to avoid recurrence. 
You could go ahead and see a gynecomastia surgeon, who can help guide your PCP through any necessary evaluation.  Quite often, because we see so many patients with this problem, the history is quite revealing alleviating the need for expensive testing. 

[gyno_bruh]

Based on your description of symptoms and your photos, it appears that you have gynecomastia.  Ultrasounds and mammograms are generally of little to no value in diagnosing gynecomastia, and these tests have value only if there is concern over breast cancer.  If your PCP is worried about that, you may have to start reaching your deductible.  If the diagnosis is not in question, but the cause is, the testing should focus on determining the cause, so that it can be addressed prior to correcting the cosmetic deformity to avoid recurrence.
You could go ahead and see a gynecomastia surgeon, who can help guide your PCP through any necessary evaluation.  Quite often, because we see so many patients with this problem, the history is quite revealing alleviating the need for expensive testing.

wow thanks for the indepth response!
i just got back from my appointment with the plastic surgeon. it was a free consultation. he did nearly the same thing as my PCP by using the flat of his fingers to push down against my chest to feel around my nipples.
he did NOT pinch behind or seem to try to feel around and behind the nipple. is this common for doctors to not try and pinch behind the nipple area?
i explained that they have been sensitive for around 6 months. he said he did not feel alot of extra breast tissue and that i am skinny enough where if he did surgery that he would not need to do liposuction, just remove part of the gland and shape it so there is no crater. he said due to my low weight he would probably not need any drains, just 2 weeks of tight bandages compressed around my chest area. and to take 1 month off of weight lifting.
but when he examined my nipple area, i was also lying back at and angle. and when lying on my back it is more difficult to see the shape of my breasts. i feel when i am standing up straight or sitting up straight then the chest shape is easier to see.
he did tell me that he does not make money in telling me this. and then he said that if i were his son he would suggest i hold off on deciding to do surgery. he only said he would feel the surgery is needed if i continue to have tenderness and pain. also that because he would be leaving some breast tissue so as to allow for proper shape, that the tenderness may not be resolved with surgery. he said to wait 6 months before i decide, to see if the pain will go away or get worse.
i am in my mid 20's.
he also said the chances of breast cancer are near 0% and he definitely doesnt think it is that. he explained he thinks its minor gynecomastia.

[DrPensler]

Gynecomastia is derived from two Greek words, gyno for feminine and mastos which means breasts. It is a medical definition,if your breasts appear feminine you have gynecomastia. patients with gynecomastia have two types of tissue in their breast ,fat (adipose) and breast (glandular) tissue. Ultrasounds and mammograms are not of value. Treatment revolves around removal of the involved tissue and redistribution of the skin envelope.