Is my gynecomastia fat or glandular?

[Sol_Invictus]

Hi,

First off, I can't begin to tell you how glad I am that I found this forum as it gives me solace that I'm not a lone "freak of nature" as I had began to see myself and that there are others who are working through the same issues as I am.

So I've been pretty much chubby all throughout my childhood, and did have mild excess chest fat. Around the time I hit my teen years was when I started to develop larger man boobs, widening of hips etc. I felt there was something wrong with my physique but never saw a physician for it as I was living with my parents who really didn't see anything out of the ordinary that required medical attention. Nevertheless the kids in middle and high school were merciless with their taunting. As a consequence, I stopped pursuing any sort of physical activity for facing ridicule and became mired in depression and poor self-esteem, and have taken various anti-depressants and anti-psychotics since I turned 17. I'm now a 25 year old male, 5'11'' and weigh 215 lbs. I've been working out at home doing P90X for about 4 months and have lost almost 25 lbs of fat, and want to continue to lose more.

However there doesn't seem to be much progress being made on the reduction of chest size. I'd like to know how severe is my gynecomastia and what are the options I have to get the best results.

Thanks for taking the time to read this.

[Dr. Elliot Jacobs]

You are obese -- not chubby (sorry).  When people gain weight, it frequently goes to the chest and abdomen.  And when weight is lost, very often those areas are the last to lose the fat.

The other part of the double whammy is that obesity encourages the growth of breast tissue.  Then, when fat is lost from the chest, there is residual breast tissue -- which will not respond to diet or exercise.

In your case, you need to reduce your weight to around 180 or so.  You will then be faced with residual (albeit smaller) tissue on your chest plus lax skin and fat on many parts of your body.  As plastic surgeons, we see these weight loss patients all the time.  Surgery to improve the "birthday suit" involves incisions to remove the redundant skin and fat and tighten the skin.  This can involve a tummy tuck, arm lift, thigh lift and appropriate gyne surgery with elevation of the nipples and removal of excess skin.

Given the photos you provided, you are not a surgical candidate at this time.  Best to lose the weight and then speak to a plastic surgeon about trimming up.

Good luck -- the P90X is a good program -- stick with it!

Dr Jacobs

[Sol_Invictus]

Thank you for responding Dr. Jacobs.

I forgot to add it in the original post that I'm not under the illusion that I'm not obese. The chubbiness was only relevent to my childhood. Obesity set in after I completely withdrew from physical activity during my teens.

Regarding the loose skin, is there any chance that my skin will somewhat adjust to my size after weight loss? I know skin has some elasticity, but as you may see from the pictures, I've got quite a few stretch marks all over my body. Does having stretch marks indicate a permanent loss of skin elasticity?

And thank you for the kind words. I'm considering losing weight for a year atleast before I consult a surgeon. I hope that will give me enough time to get in optimal condition (and save up) for my treatment.

[Dr. Elliot Jacobs]

Unfortunately, once the skin has lost elasticity (such as in obesity), there is no way to reverse it.  Your stretch marks are stark evidence of that.  They actually are areas of the skin where the elastic fibers stretched until they broke. 

Think of skin elasticity as billions of small rubber bands in your skin.  Once they are stretched out, there is no going back.  And if a rubber band breaks (ie a stretch mark), there is no way to re-attach the broken ends.

That is why anyone who was obese and loses weight will have loose hanging skin and residual fat.  It is then up to a plastic surgeon to "tailor the birthday suit."  Furthermore, weight loss and lax skin is decidedly unique-- therefore every case has to be evaluated individually.

Dr Jacobs