Classic Gynecomastia is by far the most common type seen in male breast reduction patients. It is a combination of excess fatty tissue and excess breast tissue. Classic gynecomastia requires removal of both, with or without skin tightening, depending on the age of the patient and quality of the skin.
The picture of an “ideal” chest on the left shows what a typical male chest looks like. Notice the defined horizontal line at the bottom of the chest. Now take a look at the Classic Gynecomastia picture above on the right. Notice how the enlarged breast takes on a round feminine appearance at the bottom. Roundness is caused by excess breast tissue, which prevents the underlying pectorals major muscle to show through. The excess breast tissue sags downward in a round or tear drop appearance. The defined horizontal line in an ideal chest is created by the pectorals major muscle.
The lateral views above provide a good example of how the Ideal Chest looks compared to the Classic Gynecomastia chest. Notice in the Classic Gyne image how there is increased projection of the chest starting from the areola downward. When measured, the distance from the bottom of the areola to the chest fold is greater than it would be with an “ideal” chest. The skin is expanded with this excess breast and fatty tissue. Of concern is the ability for the skin to snap back and tighten when the excess tissues are removed. With younger male this isn't usually a problem, however with older men it is, because of the aging skin and loss of elasticity. If the skin does not tighten up to the patient's satisfaction, the surgeon may recommend a minor secondary skin tightening procedure under local anesthesia.
Take a look at the Classic Gynecomastia picture above right. Notice how the nipple and areola are still flush with the skin. This is what classifies this as Classic Gynecomastia. If the areola and nipple were protruding outward and not lying flat with the skin, this would be considered "Puffy Nipple."
The components of excess breast tissue (white) and excess fatty tissue (yellow) is shown in the image above on the right. The excess breast tissue is typically located below the nipple. If you pinch the area under the nipple, you will feel a firm squishy or rubbery like nodule.
Every man has some amount of breast tissue beneath the areola. you should only consider surgical options , if your chest appearance bothers you.
The right side image below shows an example of excess fat located under and within the breast tissue. The excess fat spreads out over a larger area causing the chest to protrude outward and round out at the bottom.