What is gynecomastia and what causes it?

Gynecomastia is a benign enlargement of the glandular tissue of the male breast, caused by a shift in the balance between estrogen and testosterone. Triggers include puberty, certain medicines, anabolic steroids, obesity and illnesses of the liver, kidney or thyroid, and sometimes no cause is found. Dr. Vishal Purohit in Jaipur looks for the likely cause at consultation before discussing treatment.

How can I tell gynecomastia from chest fat?

True gynecomastia usually feels like a firm, rubbery, button-like disc under the nipple that may be tender. Chest fat (pseudogynecomastia) feels soft and spread out, without a central lump, and often improves with weight loss. Dr. Vishal Purohit in Jaipur tells the two apart by examination, because glandular tissue does not shrink with diet or exercise.

What are the grades of gynecomastia?

The widely used Simon system describes four grades: small enlargement without extra skin, moderate enlargement without extra skin, moderate enlargement with minor extra skin, and marked enlargement with excess skin that resembles a female breast. Dr. Vishal Purohit in Jaipur grades each chest at consultation because the grade guides the technique, the operating time and the cost.

Does gynecomastia in teenage boys go away on its own?

Often, yes. Breast tissue growth during puberty is common and frequently settles as hormone levels stabilise. When it does not settle, or continues after puberty is complete, a doctor should look for other causes, and the gland can become fibrous. Families in Jaipur can ask Dr. Vishal Purohit to review a teenager whose chest enlargement has persisted.

When should a man get a breast lump checked?

Any new breast lump in a man deserves an examination. A hard or fixed lump, skin changes, a pulled-in nipple, nipple discharge or swollen glands in the armpit need prompt review, because male breast cancer, though much rarer than gynecomastia, must be ruled out. Dr. Vishal Purohit in Jaipur can examine the chest and advise on the next steps.

How is gynecomastia surgery done at Kalpana Aesthetics in Jaipur?

Dr. Vishal Purohit in Jaipur combines VASER or power-assisted liposuction with removal of the gland through an inconspicuous incision along the lower half of the areola border. Surgery is done under local or general anaesthesia (sedation is never used), takes 60 to 120 minutes for simpler grades, and all removed tissue is sent for histopathology.

What does gynecomastia surgery cost in Jaipur?

At Kalpana Aesthetics, gynecomastia surgery costs ₹45,000 to ₹95,000, depending on the grade and the technique needed. Dr. Vishal Purohit in Jaipur confirms the grade at consultation and explains the plan and aftercare, including a custom medical-grade compression vest worn 24/7 for 4 to 6 weeks and mandatory follow-up visits on day 5 and at 1 month.

What is Gynecomastia? Causes, Symptoms, and Grades Explained

If you are struggling with the appearance of your chest, the first and most important step is to get a clear, medical diagnosis. In Dr. Vishal Purohit’s practice, diagnosis begins with clinical examination and direct palpation first, followed by ultrasound or MRI when imaging is needed, and hormone blood tests only when there are other symptoms of hormonal imbalance. Many men feel self-conscious about this condition, but it is crucial to know that “man boobs” are a recognised medical issue, not a personal failing.

While understanding the causes is vital, many men whose glandular tissue persists ultimately consider surgical correction. Dr Vishal Purohit specialises in Gynecomastia Surgery in Jaipur, aimed at restoring a flatter, more masculine chest contour. In this guide, we will break down exactly what this condition is, why it occurs, and how to distinguish it from simple weight gain.

Gynecomastia is the most common condition affecting the male breast. It is a benign (non-cancerous) growth of glandular and supporting tissue [1], and it typically looks and feels like a button-sized growth underneath the nipple [2]. In Dr. Vishal Purohit’s practice, gynecomastia is never a hard lump; a hard lump suggests another condition such as carcinoma or a tense cyst and needs immediate MRI or ultrasound and referral to an oncologist.

Key point: gynecomastia is a medical condition, usually driven by a shift in hormone balance. Some causes, such as puberty, are a natural phase; others, such as certain medicines, anabolic steroids or an underlying illness, can be looked for and addressed. Referral to an endocrinologist is made only when gynecomastia develops suddenly, well after puberty is complete, or when there are other symptoms of hormonal imbalance. Finding the cause comes first.

“Everyone deserves to feel good and confident about their body.” — Dr. Vishal Purohit

What Is Gynecomastia? (The Medical Definition)

Gynecomastia (often colloquially called “man boobs”) is the enlargement of male breast tissue [3].

What most people don’t know is that both men and women have breast glands; in men they are usually not noticeable [3]. Men make mostly testosterone but also some estrogen. Estrogen makes breast tissue grow, while testosterone holds that growth back, so when the balance tips toward estrogen, the glandular tissue can enlarge [3].

True Gynecomastia vs. Pseudo-Gynecomastia

It is vital to distinguish between conditions that can look very similar [4]:

True Gynecomastia: This involves the growth of glandular tissue, felt as a firm, button-like disc under the nipple that may be tender [2]. Exercising or losing weight will not reduce this breast tissue [3].
Pseudo-Gynecomastia (Lipomastia): This is caused by fat deposits without glandular growth and accounts for most breast enlargement in men with obesity. It looks like a general increase in chest size rather than a lump [2], and a weight-loss and exercise programme is the first-line treatment [4]. Dr. Vishal Purohit does not operate on obese and massively obese men because the surgical risk is too high and skin may sag after subsequent weight loss, requiring further correction; the target BMI is within the normal range, though slightly overweight men may also benefit from surgery without waiting.
Mixed Gynecomastia: Both enlarged gland and excess fat are present [4].

Do you need surgery?

Not always. Pubertal gynecomastia often settles on its own, and when a medicine or an illness is responsible, the first step is to treat the illness or stop the contributing drug [5]. Dr. Vishal Purohit does not prescribe medicines for gynecomastia, as pubertal gynecomastia does not require medication and once the gland is surgically removed it cannot grow back. Furthermore, in his practice, surgery in teenagers is considered only at least 2 years after puberty is complete. Surgery is generally recommended when gynecomastia has persisted for longer than 12 months and has not resolved on its own or with medical treatment [4]. If you are unsure about your eligibility, you can read our guide on Candidacy & Eligibility for Surgery.

Simon Classification vs. Rohrich Grading System

The two grading systems cited most often are those of Simon and Rohrich [6]. Simon (1973) grades the chest by size and loose skin [7]; Rohrich grades it by the estimated weight of tissue and the degree of droop (ptosis) [8]. The rows below sit side by side for comparison; they are not exact equivalents.

Simon grade [7]	What it means	Rohrich grade [8]	What it means
Grade I	Minor enlargement, no excess skin	Grade I	Minimal hypertrophy (under 250 g), no ptosis
Grade IIa	Moderate enlargement, no excess skin	Grade II	Moderate hypertrophy (250–500 g), no ptosis
Grade IIb	Moderate enlargement with minor excess skin	Grade III	Severe hypertrophy (over 500 g) with grade I ptosis
Grade III	Marked enlargement with excess skin, resembling a drooping female breast	Grade IV	Severe hypertrophy with grade II or III ptosis

Why Does It Occur? The Root Causes

When seeking treatment, understanding the root cause is the first step. This section is a short summary; the detailed guide What causes gynecomastia? covers each cause in depth.

Dr. Vishal Purohit explains how true gynecomastia can progress from active glandular growth to fibrosis: pubertal gynecomastia does not need medication, and once the gland is removed surgically it cannot grow back [9]; gynecomastia that persists and becomes fibrous is usually corrected surgically [4].

The Core Mechanism: Hormonal Imbalance

The underlying mechanism of true gynecomastia is an imbalance between estrogens (female hormones) and androgens (male hormones) such as testosterone [3].

While men primarily produce testosterone, they also produce small amounts of estrogen. If this balance shifts, through a drop in testosterone or a rise in estrogen, breast tissue is stimulated to grow [3]. In about one in four cases, no specific cause is found (idiopathic gynecomastia) [5].

Common Triggers by Age Group

Dr. Vishal Purohit provides this educational infographic on the causes of physiological gynecomastia across a male’s lifetime, to help patients understand hormonal shifts and natural resolution patterns before considering surgical options.

Puberty (Physiologic Gynecomastia)

During puberty, a boy undergoes many physiological changes. Sometimes, there is a transient imbalance in hormonal levels.

The Stats: Physiologic gynecomastia is reported in approximately 60–90% of adolescent boys during puberty [10].
The Outlook: It should resolve within six months to two years after onset; if it persists beyond two years or past 17 years of age, further evaluation is advised [5]. In some boys it does not regress, and the gland becomes enlarged and fibrous [4]. For teenagers seeking surgical correction, Dr. Vishal Purohit operates at least 2 years after puberty is complete.

Learn more about how age affects treatment here: Adolescents: Age & Timing for Surgery.

Medication-Induced Gynecomastia

Medicines and other substances account for roughly 10 to 25% of cases [5]. Common culprits include:

Anti-androgens (used for an enlarged prostate or prostate cancer) [11].
Anabolic steroids (often used for bodybuilding) [3]. In Dr. Vishal Purohit’s practice, steroid and prohormone users must stop for a minimum of 6 weeks before surgery, with 3 months being preferable. See steroids and gynecomastia.
Anti-anxiety medicines such as diazepam, and some heart medicines, including certain ACE inhibitors and calcium channel blockers [11].

Do not stop a prescribed medicine without first speaking to your doctor [11].

Obesity & Lifestyle

Fatty tissue is a major site of aromatase, an enzyme that converts testosterone into estrogen [12], so obesity can result in more estrogen [11]. Extra chest fat on its own, however, is pseudogynecomastia rather than glandular growth [4]. Slightly overweight men may also benefit from surgery without waiting; obese and massively obese men are not operated on because the risk is too high and skin may sag after later weight loss, needing further correction. Regarding fitness habits, protein supplements have no role in increasing or decreasing gynecomastia, whereas growing chest muscle can push the gland outwards and make it look more prominent.

Chronic Health Issues Create Hormonal Imbalance

Sometimes, gynecomastia is a sign of an underlying illness that disturbs how hormones are made or broken down. In Dr. Vishal Purohit’s diagnostic practice, evaluation begins with clinical examination and direct palpation first, followed by ultrasound or MRI when imaging is needed, while hormone blood tests are ordered only when there are other symptoms of hormonal imbalance [5]. Referral to an endocrinologist is made only when gynecomastia develops suddenly, well after puberty is complete, or when there are other symptoms of hormonal imbalance. Our guide on how gynecomastia is diagnosed explains the tests that help rule out these conditions:

Liver Disease and Cirrhosis: Liver injury can impair the breakdown of estrogens; men with alcohol-related liver disease are at particular risk [5].
Kidney Failure: Chronic kidney insufficiency is one of the recognised causes [5].
Hypogonadism: Low testosterone production, from problems in the testes (primary) or in the hormone signals that drive them (secondary), can cause gynecomastia; about half of men with Klinefelter syndrome have it [5].
Thyroid Disease: Gynecomastia occurs in 10 to 40% of men with hyperthyroidism, and restoring normal thyroid function resolves it in one to two months [5].
Tumours: Rarely (about 3% of cases), tumours are responsible, such as testicular Leydig or Sertoli cell tumours, adrenal tumours or cancers that produce the hormone hCG [5].

The Symptoms: What to Look For

How do you know if you have gynecomastia? Look for these signs:

Swelling or a lump: A button-sized growth under the nipple that you may see or feel; it may move easily and can affect one or both breasts [2].
Tenderness: The area may feel tender or sore [11].
Texture: Glandular tissue feels like a firm, rubbery disc beneath the nipple, while fat feels softer and more diffuse [10].
A “puffy nipple”: Nearly 8 to 10% of patients present with an enlarged, projecting areola without major breast enlargement [8].

Gynecomastia is most often on both sides; when it is one-sided, it is usually on the left [5].

When to get checked promptly: a hard, immobile lump, skin changes, nipple retraction, nipple discharge or enlarged lymph nodes should raise concern for breast cancer until proven otherwise [5]. Male breast cancer is much rarer than gynecomastia, but an examination is essential to tell the two apart [2]. Read more in a male breast lump: when to get it checked.

This educational infographic by Dr. Vishal Purohit distinguishes the glandular disc of true gynecomastia from the fatty tissue of pseudogynecomastia. An accurate diagnosis guides the right treatment plan.

The 4 Grades of Gynecomastia

Surgeons classify the severity of the condition to plan the surgical approach. This grading also influences the cost of gynecomastia surgery: at Kalpana Aesthetics the fee ranges from ₹45,000 to ₹95,000, depending on grade and technique.

Based on the Simon system [7]:

Grade 1: Minor enlargement with no excess skin; it may appear as a “puffy nipple” [8].
Grade 2: Moderate enlargement with no excess skin.
Grade 3: Moderate enlargement with minor excess skin.
Grade 4: Marked enlargement with excess skin, resembling a female breast.

At Kalpana Aesthetics, surgery for simpler grades usually takes 60 to 120 minutes, while grade 4 or massive gynecomastia can take up to about 4 hours. Drains are placed only in grade 4; lower grades usually do not need them.

This detailed post on Grades of Gynecomastia will clarify any further confusion.

Is It Treatable?

Yes. Pubertal gynecomastia often resolves on its own, and gynecomastia caused by a medicine or illness is first managed by treating that cause [5]. Glandular tissue that persists, however, can become fibrous and may not regress [4]. Our overview of gynecomastia treatment options compares the choices.

Medical Treatment: Medicines such as tamoxifen and raloxifene are the most commonly used, and they can help when given during the early, growing phase, before the gland becomes fibrous [9]. However, pubertal gynecomastia does not need medication, and once the gland is removed surgically it cannot grow back, whereas surgery can be done at any time with similar results [5]. See: Medical Management vs. Surgery.
Surgical Treatment: For established cases, surgery usually combines liposuction of the surrounding fat with direct removal of the glandular tissue; men with significant excess skin and droop may need a more extensive approach [6]. At Kalpana Aesthetics, Dr. Vishal Purohit combines VASER or power-assisted liposuction with gland excision through an inconspicuous incision along the lower half of the areola border, under local or general anaesthesia. All removed tissue is sent for histopathology.

Ready to Restore Your Confidence?

If you suspect you have gynecomastia, you don’t have to live with it. A consultation can confirm the diagnosis and rule out other issues.

“Everyone deserves to feel good and confident about their body.” (Dr. Vishal Purohit)

Choose your next question

Start with the question that matters most to you right now.

Causes

Recognition and diagnosis

Treatment

Surgery and recovery

Cost and choosing care

Still have a question?

Browse all gynecomastia FAQs by topic

Expert Gynecomastia Surgery & Male Chest Contouring in Jaipur

Considering treatment for gynecomastia? Schedule a confidential consultation with Dr. Vishal Purohit, M.Ch. plastic surgeon registered with the Rajasthan Medical Council (RMC Reg. 28041/14185), at Kalpana Aesthetics, Jaipur.

Surgical Procedures & Pricing: Visit our dedicated Gynecomastia Surgery in Jaipur page to review the procedure, technology options, and book your consultation.
Cost & Grade Information: Explore our detailed guides on gynecomastia surgery cost in Jaipur and gynecomastia grades & classifications.
Aftercare: Every patient has mandatory follow-up visits on day 5 and at 1 month, and 24x7 help is always available.

This is educational information, not medical advice.