January 15, 2026 | Gynecomastia
6 minute read
In order to treat enlarged male breasts, patients and physicians need to know what the cause is. This blog discusses the differences between gynecomastia (enlarged breast tissue) and pseudogynecomastia (an increase in fat) so readers can determine which condition they have and plan their treatment accordingly.
Table of Contents
- What’s Causing Your Enlarged Male Breasts?
- What Is Gynecomastia?
- What Is Pseudogynecomastia?
- What’s the Difference Between Gynecomastia and Pseudogynecomastia?
- How Are Gynecomastia and Pseudogynecomastia Treated?
At Greenberg Cosmetic Surgery and Dermatology, Stephen T. Greenberg, MD, FACS; Dr. Jason M. Weissler; Dr. Stephanie A. Cooper; and Dr. Jacqueline Ross have performed gynecomastia surgery for thousands of patients. Contact our office to learn more about how gynecomastia treatment can provide relief:
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What’s Causing Your Enlarged Male Breasts?
Noticing an increase in breast tissue as a man can be quite alarming, and for many, it causes feelings of distress and confusion. While common, experiencing gynecomastia, or an enlargement of male breast tissue, can make men feel that something is terribly wrong. Before you can get treatment, however, it’s essential that you discover the underlying cause of your enlarged breasts.
What Is Gynecomastia?
Gynecomastia is the enlargement of male breast tissue due to a hormonal imbalance, specifically an increase in estrogen levels or a decrease in testosterone. Estrogen is the hormone responsible for the development of breast tissue (in women), so an increase in this hormone paired with a decrease in testosterone can result in men developing what appear to be female breasts.
Gynecomastia, sometimes called true gynecomastia (more on that later), can affect one or both breasts and can be accompanied by tenderness, swelling, or a noticeable lump under the nipple. Patients who are experiencing this condition often feel nipple sensitivity and can even experience pain just from their clothes touching the area.
What Is Pseudogynecomastia?
Many patients experience what they think is gynecomastia, but it is actually something called pseudogynecomastia. Pseudogynecomastia is the appearance of enlarged male breasts caused by an excess of fat, not glandular tissue. This is increasingly common among men with higher body fat percentages and may be associated with weight gain or a sedentary lifestyle.
This condition is why you might see the distinction between “true gynecomastia” and pseudogynecomastia. It is very commonly mistaken by patients who simply see an increase in their chest size and naturally want to fix it.
So why the distinction? Why does it matter if your large breasts are due to glandular tissue or fat? And while that’s certainly true from an aesthetic standpoint, the treatment is entirely different for pseudogynecomastia vs. gynecomastia.
We’ll break down these differences below.
What’s the Difference Between Gynecomastia and Pseudogynecomastia?
Men experiencing gynecomastia or pseudogynecomastia often have one thing in common: they want to solve their problem. To do that, we must determine which condition you have to receive the best care. Here are the important differences to look out for between pseudogynecomastia and true gynecomastia:
Tissue Type & Feel
As stated, gynecomastia is characterized by an increase in breast tissue that feels firm, dense, and more rubbery than fat. It also develops directly under the nipple. Glandular tissue consists of lobes and ducts, paired with fibrous connective tissue, which accounts for its firm texture.
Pseudogynecomastia is composed of adipose tissue (fat), which is soft and more evenly distributed across the chest.
Causes
Gynecomastia is caused by an imbalance of estrogen as compared to testosterone, which can be caused by a variety of factors, including certain medications and illnesses. Recreational drug use and excessive alcohol consumption can also be causes, as can anabolic steroid use.
Pseudogynecomastia, by contrast, is primarily caused by weight gain and excess body fat, which are often linked to poor diet, physical inactivity, or other factors. Pseudogynecomastia is the only type of gynecomastia that can be improved by diet and exercise and may not require surgery, depending on the extent of the condition.
Physical Sensation
Gynecomastia is often accompanied by nipple or breast tenderness, swelling, and even pain in the chest area.
Pseudogynecomastia is generally not painful.
Symmetry
Gynecomastia can affect one or both breasts, and the size of the tissue growth can be asymmetric.
Pseudogynecomastia typically affects both sides of the chest evenly, and fat distribution is usually symmetrical.
Response to Weight Loss
Gynecomastia does not respond to diet and exercise; some patients attempt physical exercise to increase pectoral muscle size and “burn off” the excess breast tissue. Unfortunately, glandular tissue is not responsive to exercise or muscle gain, and increasing muscle mass can worsen the breast appearance, as increased volume pushes the chest outward.
Pseudogynecomastia, however, responds well to diet and exercise, particularly for milder cases. Your doctor will likely recommend that you start dieting and exercising to see how well you respond to this before they recommend surgery.
How Are Gynecomastia and Pseudogynecomastia Treated?
Treatment is perhaps the greatest distinguishing factor between gynecomastia and pseudogynecomastia, and once you know which one you have, the quicker you can find a solution.
How to Treat Gynecomastia
True gynecomastia does not typically respond to conservative methods like diet and exercise. However, it is important to determine the cause of your condition. If you are taking certain medications, using recreational drugs, partaking in excess alcohol consumption, or using anabolic steroids, it’s crucial that you stop what you can and discuss your options with your primary care physician. Some medications can be adjusted or swapped out, for example, which can help balance your hormones.
Next, you can discuss your options with an experienced gynecomastia surgeon. Typically, gynecomastia surgery involves the following:
- Glandular tissue excision is the only method to remove excess breast tissue. Your surgeon will make a small incision in the affected breast and surgically remove the excess tissue.
- Liposuction may be indicated to remove excess fat that may contribute to the appearance of enlarged breasts.
- Skin tightening is also necessary for patients with stretched skin due to enlarged breasts.
How to Treat Pseudogynecomastia
Since pseudogynecomastia is characterized by excess chest fat, patients typically respond well to lifestyle changes that promote weight loss, such as diet and nutrition, and to strength training that targets the chest muscles.
In some cases, liposuction may be indicated to remove excess fat. However, this is usually not the first option as it requires small incisions, which can lead to visible scars. If the excess fat is severe, however, a combination of liposuction and skin tightening may yield the best aesthetic result.
Learn More About Gynecomastia Treatment in Long Island
You don’t have to live with gynecomastia or pseudogynecomastia any longer. Let our expert surgeons guide you through the process of learning which type of condition you have, how to incorporate lifestyle changes, and finally, which surgical options will yield your ideal results. Call Greenberg Cosmetic Surgery and Dermatology today at (888) 680-2090 or complete the contact form to request a consultation.