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Causes of Gynecomastia: Why Removing Glandular Tissue Matters

Author : Dr. Ki-hun YangFebruary 19, 2026 at 05:56 PM 365

Causes of Gynecomastia: Why Removing
Glandular Tissue Matters

Gynecomastia — breast enlargement in men — is often assumed to be simply the result of gaining weight.

More accurately, however, it is a medical condition in which hormonal changes and tissue characteristics interact. In particular, quite apart from fat accumulation, the degree of glandular tissue proliferation is a key factor that determines the treatment method and outcome.

Male breast tissue is influenced by the balance between two hormones: estrogen and androgen. When estrogen activity becomes relatively stronger or the influence of testosterone decreases, glandular tissue can be stimulated to proliferate.

1. Why Does Gynecomastia Occur?

These changes are relatively common in the following situations.

Temporary hormonal fluctuations during puberty
Increased aromatase enzyme activity due to increased body fat
Certain medications (anti-androgens, some antidepressants, steroids, etc.)
Systemic conditions such as liver disease or thyroid disorders

Even when it looks like fat accumulation from weight gain, it is clinically not uncommon for glandular proliferation to be present as well.

2. The Difference Between Fat and Glandular Tissue

<Fat-type chest> <Glandular gynecomastia>

To understand gynecomastia, it is important to distinguish between a "fat-type chest" and "glandular gynecomastia."

Fat-type chest (pseudogynecomastia)

Its size changes relatively easily with changes in body weight.
On palpation, it feels generally soft and diffuse.

Glandular gynecomastia (true gynecomastia)

Largely unaffected by weight loss — the shape remains even after losing weight.
It is felt as a relatively firm lump.

3. Why Removing Glandular Tissue Matters in Surgery

In general, gynecomastia surgery consists of two main stages: liposuction and gland excision. When glandular tissue has been confirmed, reducing fat alone may not achieve the desired improvement in appearance. Because glandular tissue contains a large fibrous component, it often cannot be removed by suction alone.

Some patients also notice renewed protrusion over time when glandular tissue is left behind. This does not necessarily mean recurrence — it can be understood as a change in appearance driven by the characteristics of the residual glandular tissue.

The Importance of an Accurate Diagnosis

In gynecomastia treatment, diagnosis is the essential starting point, because the treatment method and plan can change depending on the findings. A gynecomastia diagnosis typically evaluates the following elements together.

Visual examination, palpation, and imaging performed together
Assessment of how fat and glandular tissue are distributed
Checking hormone status and screening for systemic conditions

Gynecomastia cannot be fully assessed from outward body shape alone. In rare cases, factors other than fat or glandular tissue can contribute to chest protrusion, making appearance alone an unreliable basis for conclusions.

If nothing changes even after exercise and weight management, it may help to
have the tissue characteristics evaluated together with a medical professional.

References

Gynecomastia review (etiology, mechanism, course) — Braunstein GD. Gynecomastia. N Engl J Med. 2007;357(12):1229–1237. doi:10.1056/NEJMcp070677
Drug-induced gynecomastia — Bowman JD, et al. Drug-induced gynecomastia. Pharmacotherapy. 2012;32(12):1123–1140. doi:10.1002/phar.1138

References for the medical classification, disease code, and mechanisms mentioned in this article. Diagnosis and treatment decisions are made through individual consultation.

ABOUT THE AUTHOR

Dr. Ki-hun Yang

Trueman · Complex & Revision Surgery · Male Aesthetic Surgery

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Causes of Gynecomastia: Why Removing Glandular Tissue Matters