Pseudo-Gynecomastia versus Gynecomastia

Enlarged breasts in men can be an extremely sensitive topic whatever a man’s age might be, and it can create severe emotional complexes. Unlike women, a man is considered more desirable if he has a flat and muscular chest with a minimal layer of adipose tissue on pectoral muscles. Having feminine-looking breasts is not considered manly, and many men suffer from this condition.

Gynecomastia is an increase in the volume of breasts in men. This increase in volume of mammary tissue is often caused by a hormonal imbalance and can occur in different stages of a man’s life. There are differences between gynecomastia and pseudogynecomastia, and it is important to be aware of them.

In this article, we will discuss the causes of gynecomastia and pseudogynecomastia and differentiate them from each other.

Pseudogynecomastia vs gynecomastia

About gynecomastia

Depending on what has caused it, gynecomastia can be physiological, induced by medication or secondary to health conditions. When it is physiological, it is often temporary and can occur in a newborn baby, during puberty or after sixty years old when the level of testosterone is decreased due to testicular involution

Gynecomastia can also be caused by medication that can directly or indirectly affect the balance of the estrogen-testosterone hormones in the body. In most cases, these are due to steroids or medication containing phytoestrogens from plants, recreational drugs such as marijuana, antihypertensive medication, and even medication for prostate adenoma.  

Health conditions that can be associated with gynecomastia are testicular tumors, hyperthyroidism, chronic hepatitis or cardiac deficiency.

In some cases, gynecomastia can subside on its own. If the patient is body building and taking steroids or recreational drugs, the condition can be solved by not taking them. In other cases, gynecomastia might require hormonal or surgical treatment.

With gynecomastia, the patient notices an increase in the volume of the breasts. This can lead to the patient refusing to show up in public, especially if he needs to go without a shirt on such as at the pool or beach.

Clothing style can change as well, and the patient might give up other water-related activities. It is important for the patient’s well-being to address this issue sooner rather than later to avoid emotional distress.

If gynecomastia is persistent, a surgical approach can be taken to help the patient get a more masculine chest. Breast reduction surgery, medically known also as gynecomastia, can be performed to reduce the volume of the breasts.

The plastic surgeon will remove a part of the mammary gland, as well as the fat and skin tissues that are in excess to remodel the chest. The procedure is safe and often performed under general anesthesia.

About pseudogynecomastia

Pseudogynecomastia is also known as lipomastia. It is a condition associated with excess fat on the breasts. In other words, excess fat is making the chest of the male patient look like female breasts. 

Lipomastia can occur in patients who are overweight or obese and can persist even after a weight loss program or bariatric surgery. To correct pseudogynecomastia, the plastic surgeon will often recommend liposuction or combine it with the removal of excess skin, if sagginess is also present.

Unlike gynecomastia, the plastic surgeon won’t remove any part of the mammary gland because it is not affected by this condition. Liposuction on the chest area is a procedure that can be performed with the patient under general anesthesia or local anesthesia with sedation.

The procedure takes less time than a breast reduction and the recovery time is also shorter.

After undergoing liposuction of the chest to get rid of pseudogynecomastia, the patient is advised to keep a constant weight to avoid ulterior fluctuations that could trigger an increase in the fat layer again as this might alter the results of the procedure.

What is the main difference between gynecomastia and pseudogynecomastia?

The main difference between gynecomastia and pseudogynecomastia depends on the type of breast tissue that is enlarged. If gynecomastia is present, the mammary gland tissue is bigger than normal. If pseudogynecomastia is present, the fat tissue is in excess and the mammary gland is normal.

Another difference might be that pseudogynecomastia is almost always present in both breasts while gynecomastia can also be unilateral. (Figure 1)

Diagnosis

To diagnose the condition and determine the suitable treatment, there are tests that need to be done, such as:

  • ​A clinical examination after discussing the medical history of the patient and other potential afflictions associated with gynecomastia;
  • ​Imagistic tests such as echography or mammography;
  • ​Lab tests to determine the level of estrogen, testosterone and other elements in the blood.

It is important to discuss your medical history in detail, as well as health conditions and current medication to allow the plastic surgeon to find the right diagnosis for the condition.

However, in many cases, clinical examination alone can determine if the patient is confronted with gynecomastia or pseudogynecomastia.

Conclusion

Gynecomastia occurs as a result of the imbalance between the estrogen which is in excess and testosterone which is in lower quantities. This imbalance can occur physiologically in different stages of a man’s life or can be caused by medication or different health conditions. 

Pseudogynecomastia is defined by the increase of breast size due to excess adipose tissue on the chest. This condition is commonly present in cases of obese or severely overweight patients and often evolves bilaterally.

Gynecomastia can occur in one or both breasts and can be efficiently corrected with the help of the plastic surgery procedure of the same name (gynecomastia) which involves the surgical excision of the excess mammary gland tissue and skin, similar to a breast reduction in women.

Pseudogynecomastia can be corrected with the help of liposuction on the chest area, provided the patient has a good skin tonus.

This article was proudly provided by Dr. Wilberto Cortes Plastic Surgeon Houston.

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