He Has Man Boobs – So Does He Have Gynecomastia or Pseudogynecomastia?

Amaris B.

Archive Date:

March 4, 2021

To help you understand this medical condition, let’s take a closer look at gynecomastia, and another condition that is often mistaken to be a genuine case of gynecomastia, known as pseudogynecomastia.

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Blog last updated on:

January 4, 2023

“Man boobs”, or enlarged male breasts, are actually more common than we think. As man boobs generally cannot be hidden under clothing, it can bring about psychological distress to the individual affected by it.

To help you understand this medical condition, let’s take a closer look at gynecomastia, and another condition that is often mistaken to be a genuine case of gynecomastia, known as pseudogynecomastia.

Gynecomastia vs pseudogynecomastia – what’s the difference?

Gynecomastia is a male breast disorder that affects 65% to 70% of males worldwide, young and old. It is the proliferation of breast glandular and may be accompanied by the presence of fatty tissue. This medical condition, which can affect male breasts bilaterally or unilaterally, is generally caused by hormonal imbalances while other possible causes may include the use of anabolic steroids, drug abuse and prolonged use of certain medications.

On the other hand, pseudogynecomastia (aka fake gynecomastia), is a condition with a similar appearance as that of gynecomastia, but is actually a very different condition as its cause is primarily due to increased fat deposition behind, around and under the nipple area.

“Pseudogynecomastia as compared to gynecomastia is actually less commonly seen. For such patients, I will recommend weight management and lifestyle changes as the first line of treatment, and this includes losing weight through dietary changes and exercise to tone the body. A handful may respond to this first-line treatment, but the majority will still find that the excess fat remains despite making substantial changes to their lifestyle. The next line of treatment, which can effectively permanently remove the excess fat would be liposuction or VASER Lipo,” explains Dr. Ivan Puah, Chairman of Singapore Lipo Peer Review Committee and medical director of Amaris B. Clinic, who has more than 15 years of body sculpting and gynecomastia surgery experience.

Be it gynecomastia or pseudogynecomastia, both conditions pose a very real problem for many male, from young teens to adults and even men way beyond age 50, causing physical and psychological problems, and adversely affecting their quality of life and self-confidence.    

“Patients are often confused, and unsure whether they are suffering from gynecomastia or pseudogynecomastia and it is not hard to fathom why as both conditions display similar feminie-female breasts like appearance. Now, the main difference between the two actually lies in the type of tissue that causes the breasts to look feminine and 'enlarged.'  

Gynecomastia sufferers have excess glandular breast tissue and excess fat tissues in the majority of cases. The glandular tissue is firmer and more fibrous than fat tissue, and most importantly, it does not respond to changes in exercise or diet,” says Dr. Ivan Puah.

Non-surgical fat reduction treatments such as cryolipolysis, creams, and massages unfortunately do not work on gynecomastia as claimed. The only effective and proven treatment that works is gynecomastia surgery. It may entail surgical excision of the glandular tissues and liposuction to remove the fatty tissues for patients who present with mixed gynecomastia (where glandular and fat tissues are the culprit).

“I see a lot of young males with less than 10% body fat, who are into fitness training and bodybuilding. The primary cause of enlargement for this group of patients is due to the development of enlarged glands for which they will only require glandular excision and these cases are what we term as True gynecomastia, ” explains Dr. Ivan Puah.

Is your loved one suffering from gynecomastia?

When your boyfriend, son, brother or husband suffers from such male breast disorder, he may choose to keep it to himself. However, you may start to notice that there is a change in his behaviour or demeanour. He may become easily moody or even depressed. Choosing to hide under layers or baggy clothes is also a tell tale sign that he is lacking body confidence. Watch out if he gradually withdraws from social activities, finding no pleasure in activities he used to enjoy, avoid undressing in front of you or others and observe his body language to see if he is constantly slouching.

Physically, he may complain about soreness or discomfort on the breasts, and in some cases, although rarely, discharge may occur. It is important to recognise these signs, both psychologically and physically, and address them as early as possible. Leaving them alone, can adversely lead to deep-seated feelings of low-esteem, social withdrawal and for some, depression. You can help him by encouraging him to seek medical treatment for a proper clinical assessment so that he can understand his issue and know that help is available for his medical condition.

If he allows, you may want to perform a quick pinch and visual test on him to determine the extent of his condition. If you feel a mound of fibrous and firm tissue when pinching his breasts, it is almost certain he has gynecomastia. Apart from that, an enlarged male breast is highly visible when he is wearing a form-fitting shirt as well. In some serious cases, the breasts look like female-breasts with a certain degree of droopiness and loose skin present.  

At this point in time, the next best option is for him to see a doctor who is experienced in treating this issue to assess him and advise on the next best step, whether he would need further observation or a gynecomastia surgery is required.

Gynecomastia surgery

It may sound gruesome but gynecomastia surgery is not as invasive as one imagines. Depending on the patient’s clinical condition, Dr. Ivan Puah may perform his proprietary approach known as 360° Glandular Tissue Dissection (360°GTD®) to permanently remove the excess glandular tissue in combination with his MDC-Sculpt Lipo technique to thoroughly get rid of excess fatty tissue. This combo treatment applies to those who are suffering from mixed gynecomastia, which accounts for over 85% of the gynecomastia cases he has treated. True gynecomastia cases will require only surgical excision without liposuction or VASER Lipo.

“Each gynecomastia case is unique and requires an individualised approach to ensure that not only the glandular tissues and fatty tissues are removed effectively, but also, the chest is meticulously sculpted and defined, according to the individual’s body shape,” explains Dr. Ivan Puah, who has received dedicated training in gynecomastia surgery in the US.

Choosing a gynecomastia doctor in Singapore

Choosing a gynecomastia doctor in Singapore - Dr Ivan Puah, Amaris B. Clinic

Wanting to have a surgery is a huge decision, and that is why it is important to find the right doctor with the knowledge, accreditation, experience and keen aesthetic sense to yield the desired results. When looking for a doctor who does gynecomastia surgery, it is imperative to find one that performs the surgery regularly and has a proven track record of case studies with a high satisfaction rate and consistent results.

Not only that, the doctor must also display confidence, be able to present a variety of gynecomastia cases that he has performed and answer your queries, addressing all of your concerns regarding the procedure.

Body sculpting: 30% science and 70% art

This is Dr. Ivan Puah’s philosophy when it comes to body sculpting. Just like a sculptor who creates masterpieces with his chisels, Dr. Ivan Puah believes that it takes both the scientific know-how, attention to detail and a keen artistic sense to create well-contoured results.

Dr. Ivan Puah  is accredited by MOH to perform liposuction, accumulating more than 15 years of liposuction and body sculpting and enhancement experience. He is also a VASER® Certified Physician who has undergone fundamental and advanced body sculpting training in Colorado and Argentina under the pioneers of VASER. Additionally, he is trained in syringe liposculpture under the mentorship and guidance of a renowned French plastic surgeon.

Dr. Ivan Puah’s “30% science, 70% artistic sense” approach to body sculpting treatments has earned Amaris B. Clinic multiple accolades, including the 2019 Body Sculpting Service Provider of the Year Award in APAC, 2020 Body Sculpting Medical Centre of the Year Award in APAC and 2020 Integrated Healthcare Medical Centre of the Year in Asia Pacific. These awards are only given to entities that have maintained high standards in quality care, and are judged based on market research, consumer survey, and by a panel of industry and medical experts.

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