The Difference Between Gynecomastia and Pseudogynecomastia

Gynecomastia and pseudogynecomastia are two conditions that affect males, with key differences. These conditions both refer to the appearance of men having breasts, characterized by excessive fat or swollen tissue in the chest area. Both conditions can show up in males of any age, but they are most common amongst newborns, teens, and seniors. 

Though gynecomastia and pseudogynecomastia patients share the same primary symptom — the appearance of breasts — what differentiates them is the type of tissue. Gynecomastia is characterized by excessive glandular and stromal tissue, with a number of potential causes. Alternately, pseudogynecomastia is due to an excessive amount of fatty tissue.

There is not a medical risk to having either condition, but many patients suffer from psychological distress as a response to gynecomastia or pseudogynecomastia and experience shame or self esteem issues related to showing their body in public. Occasionally, gynecomastia can be a symptom of a more serious health issue, so patients are advised to also speak with their GP about potential causes. Though this is rare, it’s always best to check.

How to Know if You Have Gynecomastia or Pseudogynecomastia

Gynecomastia and pseudogynecomastia are fairly easy conditions to diagnose. They both present as excess tissue resulting in a soft, breast-like appearance on the chest. Many men with gynecomastia or pseudogynecomastia are aware of their condition early on, and harbor insecurity about their appearance.

There are other, less-recognized symptoms that can be attributed to these conditions, as well. Beyond the recognizable chest tissue, gynecomastia and pseudogynecomastia each have a handful of symptoms that can confirm a diagnosis.

Gynecomastia Symptoms

• The physical appearance of breasts
• Swollen or puffy nipples
• Tenderness in areola that is painful to the touch 
• A mound or disc of glandular tissue in the chest that is firm to the touch
• Occasionally, soft, fatty tissue beneath the chest (this is not always present)
• Nipple sensitivity

Pseudogynecomastia Symptoms

• A bilateral breast-like appearance to chest
• Only fatty tissue beneath the chest — nothing will feel firm

What Causes These Conditions?

For patients hoping to treat their condition, it’s helpful to learn what caused it in the first place. In the case of gynecomastia and pseudogynecomastia, the causes are different. 

There are several potential causes for gynecomastia, while pseudogynecomastia has only one.

Gynecomastia Causes

• Hormones: Hormonal changes and issues are frequently behind gynecomastia cases. This can come about in a number of ways. For newborns with the condition, gynecomastia is caused by estrogen passed onto the baby via placenta. Hormone-driven gynecomastia in infants generally resolves with time. In teenagers, puberty causes hormones to go haywire — and sometimes, testosterone levels drop so low that existing estrogen causes breast tissue growth. Finally, older men tend to develop gynecomastia due to less production of testosterone with age.
• Certain Medications: In some cases, specific medications can contribute to the development of gynecomastia. Patients who are on antidepressants, steroids, or medication to treat heart problems, ulcers, and prostate issues are more likely to develop gynecomastia. Some antibiotics can also be the culprit. For medications with estrogen or that impact estrogen levels, gynecomastia can result. 
• Alcohol Use and Liver Problems: Those who struggle with alcohol consumption and suffer from cirrhosis can be more susceptible to gynecomastia than their peers. 
• Thyroid Issues: The thyroid is a hormone-producing gland located in the throat. Occasionally, patients with thyroid-related issues develop symptoms of gynecomastia.
• Narcotic Use: A number of narcotics, namely cannabis and heroin, have been linked to the development of gynecomastia. 
• Kidney Issues: While very rare, gynecomastia can be brought about by kidney failure. If gynecomastia symptoms appear with those associated with kidney failure, it is important to seek medical help immediately. 
• Testicular Issues: Occasionally, gynecomastia can point to serious testicular issues, including infection or even cancer. Patients experiencing both gynecomastia and other testicular failure symptoms are advised to seek medical attention.
• Klinefelter Syndrome: This rare syndrome is characterized by an extra X-chromosome. Patients with Klinefelter Syndrome sometimes develop gynecomastia.

Pseudogynecomastia Causes

• Obesity: While gynecomastia has a number of causes, pseudogynecomastia is more straightforward: it’s caused by excess fat. Patients who experience pseudogynecomastia are carrying a large amount of fatty tissue in their chest, and it presents as breasts. 

Treatments: Gynecomastia vs Pseudogynecomastia

Because gynecomastia and pseudogynecomastia have different causes, they are also treated differently.

Gynecomastia Treatment

There are two main ways to treat gynecomastia: through medication or surgery. While some patients find success by taking medications to stabilize their hormone levels, others find that surgery is a more reliable option. Gynecomastia surgery is a straightforward and minimally-invasive procedure. It involves the removal of fat and tissue from the chest area, typically completed with one simple operation. 

There are two different techniques of gynecomastia surgery. Which type a patient receives will depend on the degree of their gynecomastia condition. In mild gynecomastia cases, surgery involves liposuction via an incision around the areola. In more severe cases, this procedure involves a second step, where the physician makes an incision along the lower border of the areola before surgically removing tissue. The incision is then closed with sutures.

Pseudogynecomastia Treatment

To treat pseudogynecomastia, most doctors recommend starting by making changes to one’s diet and activity levels to promote weight loss. If, following significant weight loss, a patient still has the appearance of breasts, the culprit may have been gynecomastia after all, and surgery would be an appropriate treatment.

Pseudogynecomastia Surgery in Southeast Texas

Dr. Leo Lapuerta has been serving the Southeast Texas community as a plastic surgeon for over 20 years. If you are considering options for dealing with gynecomastia, get in touch today for a confidential consultation on your unique circumstances and options. We operate in Houston, Katy, Pearland, and Piney Point. 

We can’t wait to meet you and help your confidence soar.