The difference is what you can feel. True gynaecomastia is firm, rubbery glandular tissue sitting directly behind the nipple, often tender, and it has a definite edge you can pinch. Chest fat is soft, spreads evenly across the chest and has no discrete edge.
It matters for two reasons: the operations are different, and Medicare only rebates one of them.
How they differ
| Gynaecomastia | Chest fat | |
|---|---|---|
| Texture | Firm, rubbery, discrete | Soft, diffuse |
| Location | Centred behind the nipple and areola | Spread across the chest, often into the armpit |
| Tenderness | Often tender, particularly early on | Not tender |
| Response to weight loss | Little or none | Usually reduces |
| Nipple appearance | Areola may look puffy or domed | Usually normal |
| Usual treatment | Excision of the gland, often with liposuction | Liposuction, or skin excision after weight loss |
| Medicare | Items 31525 / 31526 if criteria are met | No rebate |
The test you can do yourself
Lying on your back, pinch the tissue behind the nipple between thumb and finger and compare it with the tissue a few centimetres out towards the armpit. Glandular tissue feels like a firm disc with an edge; fat feels the same everywhere. If there is a clear difference, there is probably a glandular component.
This is a guide, not a diagnosis. Many men have both — a glandular disc within a generally fatty chest — which is one reason the operation often combines excision with liposuction.
Why it is not just cosmetic labelling
Medicare item 31526 requires the enlargement to be not due to obesity and not proportionate to your body habitus, with photographic evidence in your notes. A chest that is heavy in proportion with a heavier build does not meet it, whatever it is called. The full criteria and the rebates.
Causes worth investigating
True gynaecomastia is a glandular response, and it has causes worth looking for with your GP before surgery:
- Normal hormonal phases — newborn, puberty and later life
- Medicines, including some used for prostate conditions, reflux, heart conditions and mental health
- Anabolic steroid use, current or past
- Alcohol, and some recreational drugs
- Thyroid, liver or kidney disease, and less commonly hormone-secreting tumours
Puberty-related gynaecomastia often settles on its own within a couple of years, which is a reason not to rush to surgery in a teenager. Where a cause is found and treated, the tissue may reduce without an operation.
See your GP promptly about a new one-sided lump, skin dimpling, nipple discharge or a lump that feels hard and irregular. Male breast cancer is uncommon but it exists, and it is excluded rather than assumed.
After major weight loss it is usually neither
Men who have lost a great deal of weight typically have loose skin and a deflated, low-sitting chest rather than gland or fat. That is a skin problem and is addressed differently. Male chest contouring after weight loss.
Common questions
Will losing weight fix it? It will reduce fat. It will not remove glandular tissue, which is why some men find the chest looks worse after weight loss — the fat goes and the disc remains.
Will training my chest help? Building the muscle underneath can make a glandular disc more obvious, not less.
Do I need a scan? Not usually for typical bilateral gynaecomastia. Imaging is used where there is a one-sided or atypical finding.
Is liposuction alone enough? Where the problem is genuinely fat, often yes. Where there is a glandular disc, liposuction alone tends to leave it behind.
Is it just puffy nipples? Where the tissue is confined behind the areola, that is the usual presentation. Puffy nipples.
Next step
Examination settles this in a few minutes. Bring a GP referral — it is required to see Dr Kumar — and any investigations already done. Call 1300 267 726, or send photos first if you are travelling. More about gynaecomastia surgery.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
