Fatty Gynecomastia / Enlarged Male Breasts

Fatty Gynecomastia (Pseudo-Gynecomastia)

By definition, gynecomastia that is primarily caused by excess fat is called Pseudo-Gynecomastia. Weight loss is the best treatment for this problem, however, in some cases diet and exercise is not enough. This is especially true of gynecomastia, or pseudo-gynecomastia, and when “love handles” are present, as these two areas do not respond well to weight loss. Typically, in these areas, the body accumulates excess fat even when at ideal body weight. That said, however, weight loss is the suggested first line of treatment.

Do I need to have breast tissue removed or will liposuction alone be enough?

This is the perhaps the most common question asked by educated patients with gynecomastia. If you are asking this question, then you have done a lot of research. Some surgeons suggest that liposuction alone will take care of the problem. Others believe that breast tissue removal is also necessary. The truth is: It depends!

Observe the pictures below.

Diagram showing muscles of male chest with classic gynecomastia Fatty gynecomastia - male breast reduction from Orange County plastic surgeon, Joseph T Cruise, MD
Classic Gynecomastia Fatty Gynecomastia

In the above diagram, we have outlined the main differences between Classic Gynecomastia and Fatty Gynecomastia. Look at the profile(s) of each chest. The right side of each man’s chest is identical. In fact, these types of gynecomastia look the same on the outside. However, when you look at the cut out view of the left chest, you will notice the Fatty Gynecomastia clearly has more fatty tissue (represented in yellow) than Classic Gynecomastia. So, although the overall shape is the same, the underlying causes are not identical. This is the reason some types of gynecomastia are determined at the time of surgery.

Liposuction alone works well to eliminate Fatty Gynecomastia but often leaves significant breast tissue behind causing Classic Gynecomastia. Removing excess fat from Classic Gynecomastia may turn the chest into a smaller chest with Puffy Nipples.

Male chest with classic gynecomastia - anatomic view Diagram showing muscles of male chest with puffy nipple gynecomastia
Classic Gynecomastia is represented on the left. Liposuction alone often leaves excess breast tissue behind, creating a “Puffy Nipple” appearance as shown on the right

Notice on the profile that Fatty Gynecomastia has very little, if any, breast tissue. Liposuction alone may effectively treat these types of gynecomastia but it must be done properly, as the fatty tissue is fibrous and resistant to removal.  The fatty tissue in this area is much more resistant to removal than other areas of the body.

Nipple placement in fatty gynecomastia

Fatty Gynecomastia Profile view