Gyno or pseudogyno? New and need help

[robear35]

I am 28 (6 foot 170 pounds) and have had puffy nipples as long as I can remember.  When ever I pinch them or its cold they are normal but most of the time they are puffy.  There doesn't appear to be any hard tissue its all soft. 

They were never really that noticeable in a t-shirt or polo.  Over the past year that has changed.  You can now considerably see my boobs though t-shirts and polos.

I have been taking Propecia on and off for the past three years and not been eating to healthy and gained a few pounds. I still look skinny though.  Could that be contributing to the growth? Any advice?  Should I try working out more or getting surgery?

Please tell me what you think.   

In the fist picture I pinched one nipple and it is hard and the other is puffy.The second picture is from the side and they are hard.  The third picture is from the side puffy.  The final picture is up close puffy. 

[Dr. Elliot Jacobs]

You are slender and have some mild excess tissue on your chest as well as puffy nipples.  The Propecia that you have taken may or may not have added to the problem -- but there is no way to test for that.

No need to debate whether you have gyne or pseudo-gyne -- the treatment (surgery) is the same.  And I never make the distinction at all.

If you do opt for surgery, then do your homework, take your time and find the best and most experienced gyne surgeon in your area.  If you cannot find such a specialist, then consider traveling to a specialist.

Dr Jacobs

[robear35]

Thank you Dr. Jacobs,

How come my nipples look normal sometimes and puffy others?

[Paa_Paw]

The nipples are very sensitive whether or not a man has Gynecomastia. They will react to friction and temperature among other things. It is kind of like how you have goose bumps when you are cold but not when you are warm. 

[Dr. Elliot Jacobs]

How come my nipples look normal sometimes and puffy others?

The normal anatomy of a nipple (male or female) includes a thin muscle layer that is located within the pigmented skin surrounding the actual nipple (it is called the areola).  When exposed to cold, manipulation or intense emotions, the muscle will tighten up.  This produces the little ridges on the skin of the areola and makes it look wrinkled.  It also will diminish the areolar diameter slightly and oftentimes make puffy nipples look better because the tightened tissue literally pushes the excess breast tissue under the nipple downwards.  Unfortunately, when the muscle relaxes, the puffiness returns.

This is a normal physiological process and cannot be changed with surgery.  When surgery is performed for puffy nipples, it is the excess breast tissue directly beneath the areola which is removed -- this then allows the areola to lie flat and flush with the surrounding skin.  The muscle remains intact and active.

Dr Jacobs