Author Topic: Gynecomastia Forum - Fat or Gyno?  (Read 12031 times)

Offline DrBermant

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Gynecomastia Forum - Fat or Gyno?
« on: March 19, 2011, 05:30:28 PM »
Fat or Gyno? I am overweight and do not like my breasts. I lost some weight but my breasts stay the same.

"Fat or Gyno" is a frequent question here, but misses the point.  Gynecomastia is a contour problem.  All male mammals with have gland.  All fat men and women have big breasts. 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. Pseudogynecomastia is a bad term that 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.

Defining a contour 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 Photos can show a region that compresses differently.  Even clinical examination of the male chest such as a pinch test (that I have been talking about here on this forum for many years) can be difficult to differentiate gland vs. fat.

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.

BMI Calculator (Body Mass Index) may be a starting point. Unfortunately, BMI does not take into account bone, muscle mass, vs. fat.  Body Fat Analyzers can help define that issue.

Weight loss before surgery is usually much better than weight loss after surgery. As a Surgical Sculptor I prefer to use a coarse tool first, then one of refinement. Weight loss is a coarse tool, Plastic Surgery is better reserved for refinement.

Hope this helps,

Michael Bermant, MD
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Michael Bermant, MD
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