If your chest seems larger than normal, you may wonder if it’s just extra fat or something more. “True” gynecomastia is caused by glandular tissue growth, not just weight gain, and it often won’t go away with diet and exercise alone. Understanding the difference between fat-based and glandular gynecomastia is key to finding the right treatment.
Dr. Ronald H. Schuster, MD, a board-certified plastic surgeon in Baltimore, Maryland, specializes in male breast reduction techniques. With years of experience, he can determine the cause of your chest fullness and the right treatment.
Fat vs. Glandular Gynecomastia: What’s the Difference?
Gynecomastia isn’t always caused by the same issue. Some men develop fatty deposits in the chest which gives them a fuller shape. Others have glandular gynecomastia, which happens when hormonal changes cause firm breast tissue to grow beneath the nipple.
How to tell the difference:
- Fat-based gynecomastia (pseudogynecomastia): The chest feels soft, and fat is evenly spread across the area rather than concentrated in one spot. It may fluctuate with weight changes, meaning significant weight loss can reduce its size, but the chest may still look full. In some cases, loose skin can remain even after fat reduction, creating a sagging effect. This is most common with general obesity or liver disease.
- Glandular gynecomastia (true gynecomastia): This type is caused by the growth of dense glandular tissue, which forms a firm or rubbery lump beneath the nipple. Unlike fat, glandular tissue does not shrink with weight loss and can be persistent even in men who are otherwise lean. It may also cause tenderness or sensitivity, particularly when pressed. This occurs mostly in guys who use performance enhancing hormone medications, as well as patients who have hormone producing tumors (Prolactinomas) or disorders.
- Combination: Truth be told – this is the majority of patients. Most patients have an element of both. There is usually a larger fatty component that surrounds a smaller more dense glandular portion. Sometimes the glandular portion is bigger but not so dense. Instead it is a very fibrous network which is mixed in with the fat. Treatment must include liposuction to get rid of the fat as well as surgical removal of the glandular/fibrous portion.
The best approach to male breast reduction depends on whether the enlargement is caused by excess fat, glandular tissue, or both. Dr. Schuster uses special techniques for either scenario:
- Fat-based gynecomastia (pseudogynecomastia): Liposuction alone may be enough to remove fat and refine the chest shape. Ultrasonic-assisted liposuction (UAL) helps break down denser tissue for a more even result.
- Glandular gynecomastia: True gynecomastia requires surgical excision to remove firm glandular tissue that liposuction alone cannot treat. Dr. Schuster specializes in the lateral pull-through technique, which removes glandular tissue through a small incision on the side of the chest rather than on the areola. This method reduces scarring.
- Excess skin removal: In most cases, the skin retracts naturally with the help of a compression vest. If loose skin remains, Dr. Schuster can remove it with minimal scarring.
Many men have a mix of fat and glandular tissue. In these cases, a combination approach is the best solution for long-lasting results.
Schedule a Consultation
If you want a flatter chest, Dr. Ronald H. Schuster, MD, can help. Call 410-593-0691 to schedule a consultation in Baltimore, MD, and let’s discuss your treatment options.
