GYNECOMASTIA AND THE PINCH TEST

Society tends to judge a males’ masculinity based on what they think is the
accepted characteristics and traits a man should have. If a male has female-like
characteristics, it can greatly affect their psychological health, emotional health,
and social well-being. One of these female-like characteristics is having female-like
breasts. There a several reasons why a male develops a female-like breast. The
most common reason is due to a breast disorder called gynecomastia which
affects about 60% of men around the world.

Gynecomastia is also known as “man boobs” or “moobs.” But not all cases of
males who are having man boobs are a result of a breast disorder as it can also
be a result of being overweight. A test called the pinch test can reveal if it is
gynecomastia or not. In this article, we will discuss everything about
gynecomastia and the pinch test to help males suffering from this condition. It
can help them decide whether to take a male breast reduction surgery to resolve
this matter.

What is Gynecomastia?
The term gynecomastia came from the two Greek words gynec and mastos which
translates into “female-like breast.” This condition occurs when the breast tissue
enlarges due to a hormonal imbalance. This imbalance happens when the
testosterone levels decrease while the estrogen levels increase. Factors that cause
this hormonal imbalance include:

 Other medical conditions

 Age
 Genetics
 Massive weight loss
 Drug use
 Anabolic steroids abuse
With this condition, it may be one-sided or may affect both breasts. Since it
has can be caused by several factors, the specific cause can be unknown. Because
of this, when diagnosing this condition, it should come up with a conclusion if
the condition is true gynecomastia or pseudo gynecomastia.

What is the Difference Between True Gynecomastia and Pseudo Gynecomastia?

Without prior knowledge, it can be difficult to distinguish true gynecomastia
from pseudo-gynecomastia. In true gynecomastia, the breasts can be firm and
tender like a female breast since a similar breast tissue causes the breasts to
enlarge. On the other hand, pseudo-gynecomastia is experienced by overweight
males as fat is accumulated on the breasts enlarging them. Usually, the size of
the breast is proportional to the size of the body. This is why pseudo-
gynecomastia is also called fake gynecomastia but having this condition can lower
one’s self-esteem and confidence. There is also a widespread type of
gynecomastia called mixed gynecomastia. As the name implies, it is a combination
of the two as it involves the breast gland and accumulated fat.

Furthermore, gynecomastia can be classified according to its underlying cause

which can be physiological or pathological. Physiologic causes include a hormonal
imbalance between testosterone and estrogen in the breast tissue. On the other
hand, pathological causes include medical conditions that resulted in breast
enlargement. Some of these medical conditions include:

 Hypogonadism
 Hyperthyroidism
 Pituitary insufficiency
 Tumors
 Kidney failure
 Liver failure
What are the Symptoms of Gynecomastia?
Gynecomastia can occur in adolescents and adults and can have varying severity.
Regardless of the severity, here are the common symptoms of gynecomastia:

 Painful or swollen breasts

 Breast tenderness
 The appearance of movable tissue beneath the nipple
 A bloody discharge from the nipple
 Secretion of fluid similar to breast milk
 Itchiness in the nipple and underarm
 Sudden feelings of being unwell
 Mood swings and changes in sex drive

Take note that if the male experiences no other symptoms aside from swelling
and the breast tissue is fatty, this case is pseudo-gynecomastia.

If the patient is exhibiting symptoms of true gynecomastia, its severity can be

assessed using a four-grade categorization.

 Grade 1 in which the breast enlargement is minor and very unnoticeable.

There is slight swelling but there is no presence of excess skin.
 Grade 2 in which the breast enlargement is moderate and unnoticeable
when wearing loose clothing. There is no presence of excess skin.
 Grade 3 in which the breast enlargement is moderate to severe and is
highly noticeable. The swelling may become severe and there is a presence
of excess skin.
 Grade 4 in which the breast enlargement is significant and severe. There is
substantial excess skin and gives the male a feminine breast appearance.

How is Gynecomastia diagnosed? What is a Pinch Test?

If the male is experiencing breast enlargement along with some other symptoms,
it is wise to visit the doctor right away for an accurate diagnosis.
To diagnose the condition, first, the medical history of the patient will be
reviewed. The doctor will examine if the gynecomastia is caused by physiologic
factors or is drug-induced which is primarily caused by anabolic steroids.

A physical exam is also conducted by the doctor to find out if the condition is
true gynecomastia or pseudo gynecomastia. This is the pinch test. It is done by
having the patient lie on his back. The doctor will then use his thumb and
forefinger to examine the breast tissue. If the doctor feels a rubbery or firm
mass of disk-shaped tissue beneath the nipple, then the condition is true
gynecomastia. If no such tissue exists, then it is pseudo-gynecomastia.

Other tests that can be done to obtain a more accurate diagnosis may include
imaging tests using a mammogram to obtain a radiologic picture of the breast
tissue. An endocrine hormone test can be done to assess the levels and balance
of the hormones. A blood test can also be done to assess kidney, liver, and
thyroid function which can help determine the underlying cause of the condition.

How is Gynecomastia Treated? How is Male Breast Reduction Surgery Performed?

Surgery is the best treatment option for gynecomastia as it is a permanent
solution. When the patient undergoes the male breast reduction surgery, the
breast tissue will never return. Depending on the severity, the methods of male
breast reduction surgery vary.

 Breast Gland Excision with Liposuction. This is the standard procedure. It

is best for patients whose condition is not yet severe (Grade 1 and 2).
This is regarded as the most successful way of performing male breast
reduction surgery. In this method, an excision is made on the breast gland
while having fat removed from the chest. This can successfully remove the
breast tissue while contouring the chest area.
 Two-Stage Procedure. This is the procedure recommended for patients on
the Grade 3 classification. As the name implies, there are two stages for
this procedure. First is the standard procedure. The second stage is called
 peri-areolar lift which is done after 4 to 6 months to let the blood
supply re-establish on the nipple-areola. This stage is the skin reduction
done by making an incision around the entire areola which is followed by a
second larger incision which makes the tissue between the incision to be
doughnut-shaped. The tissue is then removed and the incisions are closed.
 Double Incision Mastectomy. This is the procedure recommended for some
patients on the Grade 3 and all on the Grade 4 classification. At the
beginning of the procedure, the nipple-areola complex is completely
removed before the incisions. The incision is larger as it extends from the
breast fold up to the armpit and it may still be larger depending on the
size of the redundant tissue. Once the tissue is dissected off, the table is
raised to have the patient in a sitting position to inspect the effects of
gravity and how much is the proper amount of skin to make a tight and
contoured chest. The nipple-areola complex position is also reviewed to
make sure that it is well balanced and aesthetically correct.

Conclusion
Having feminine-like breasts is embarrassing and can greatly affect the male’s
psychological health, emotional health, and social well-being. Luckily, gynecomastia
can be accurately diagnosed using the pinch test combined with other tests.
Furthermore, surgery is available no matter how severe the condition is and all
are proven to be successful and effective.

Meta Description:

Are you embarrassed about having man boobs? This may be caused by a condition
called gynecomastia. Find out more about gynecomastia and the pinch test here.

Reference: https://www.gynecomastia.org/