How many of you guys have had this happen? I have seen several physicians and get a different diagnoses concerning the composition of my gyne. Fat or gland is always a big question on these boards, but look at what I have encountered!
Doctor#1- Endocrinologist: "There is no gland."
Doctor#2- Plastic Surgeon: "Look here! You have a bud. I have to cut that bud out!"
Doctor#3- Radiologist: "You do not have gynecomastia. X-rays show the composition to be pure fat...at least that way it is more likely to regress"
Doctor #4- Internist: " No gland.... It would be more likely to regress if it were gland. But since its all fat, it won't regress. See a plastic surgeon."
Dr. #5- Plastic Surgeon: "You do have Gynecomastia. Although radiology did not show a clump of gland, you do have glandular material thru out the fatty tissue. I must excise that gland and lipo the fat.
Who's right? Who's wrong? Where do I go from here?
I was under the understanding that radiology would confirm composition. I know that upon self examination I can only feel fat and muscle. But then again, Doctor #5 might be right.
Any comments would be greatly appreciated.
Helping others understand your 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.
Male Mammograms can define radio dense gland. However in my opinion, I prefer to view X-rays
during my examination to enhance my evaluation. It is rare for a radiologist to examine the patient in addition to viewing the film. I do not order mammograms for my typical gynecomastia patient. I reserve this tool for those with a clinical finding that concerns me.
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. I prefer the original meaning of the word by Galen who first used the phrase: female like breasts. If the contour looks female, then you have gynecomastia wether it is fat and or gland. Female breasts come in many different forms from the small puffy nipple of a developing breast to a large hanging structure.
I prefer to treat the contour, how it looks. If there is a concern about a female like contour, I try to sculpt a male like chest. Picking your surgeon is like picking an artist. Not all surgeons have the same skills.
Hope this helps,
Michael Bermant, MD
Learn More About Gynecomastia and Chest Sculpture
Topic: Conflicting diagnoses- I'm confused (Read 2526 times)
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