What’s in a Name?
We were responding to questions in the “ask a surgeon” forum on gynecomastia.org the other day when we ran into an engaging debate. A few guys were discussing the merits of various terms used to describe man boobs, including:
• Pure gynecomastia
• Glandular gynecomastia
Interestingly, the discussion got rather heated!
You may think it’s amusing that men can get worked up over semantics, and at face value it is. But there’s a serious side to the terms used by patients and doctors to talk about enlarged male breasts, and that’s because terms can dictate treatment strategies—sometimes not in a good way—and negatively influence the ways guys view their options.
Here’s the way we discuss this topic with our New York man boob patients.
First Things First
One of the first things we tell guys we talk to is this: no one knows exactly what’s under the skin until incisions are made. The fact is, fat can sometimes feel knobby and gland can sometimes seem soft. Although educated guesses can be made, especially where bodybuilders and obese guys are concerned, surgery can actually be full of surprises. Highly experienced gynecomastia specialists will tell you this readily, and they’ll be prepared to handle whatever tissue they find under the skin.
If You’ve Been Told It’s Gland Only
The original poster on gynecomastia.org said he was told his case was “pure gynecomastia.” We presume that means his doctor suspected there was only breast gland tissue to remove. But that doesn’t mean surgery with just a scalpel is the answer. We would advise patients who hear this to quiz their cosmetic surgeon with questions like these: Will you know if removing breast gland has created a crater deformity? How do you handle crater deformities in the operating suite? How will you make sure my skin ultimately drapes smoothly over natural looking contours?
Even when a surgeon believes that the culprit behind a case of moobs or puffy nipples is just breast gland, there are still key ways fat and skin play a role in getting good results. Here’s an example of the way we and other gynecomastia specialists talk with guys who may think they need “gland only” surgery.
If You Think It Could Be Fat Only
One term popular with patients and even medical professionals is highly misleading, in our view: “pseudogynecomastia.” It’s used when man boobs are thought to consist of excess fat only. When we hear it from a guy in our New York man boobs consulting room, we set him straight right away. Because it creates its own environment including elevated estrogen levels, excess fat always stimulates at least a little breast gland growth.
The main reason we object to the term “pseudogynecomastia” is that it can imply treatment with liposuction only or even one of the non-invasive fat removal methods is a viable solution. It’s not. A large percentage of guys who seek us out for revision gynecomastia surgery in New York are those who have had liposuction only, the result being uneven contours.
There are other reasons we object to the notion of fat-based moobs. One is that men and boys who are overweight sometimes think diet and exercise is the solution to a case of gynecomastia. We applaud guys who work to get in shape, but as they reduce some of the excess fat on their chest they often find their man boobs become even more prominent. A cruel irony!
We have occasionally run across guys who, believing they have pseudogynecomastia, think their condition is not worth treating. We do not feel that way at all! As we stated in a discussion of this topic on gynecomastia.org, “If you have it, and it bothers you, it’s worth addressing.”
In truth, treating a case of man boobs is quite a bit more tricky than it may seem. That’s one reason we have enjoyed working with guys with moobs for decades. No two cases are alike and we learn something new from each one. It’s also why we eventually designed and patented our own instruments just for male breast reduction.
Remember the comment above about gynecomastia surgeons needing to be ready for anything? After nurturing this area of specialty in our practice for three decades, we believe we are. And we would enjoy treating your case too. If you’d like to work with us, send us email today!