Most patients presenting to the plastic surgery office for evaluation of gynecomastia report fairly long-standing chest fullness since puberty. Both breasts are affected symmetrically, and there is no history of pain or nipple discharge. Occasionally, the breast tissue is vaguely tender on exam. Most patients have diffuse chest fullness, others present with an isolated collection of well-defined and firm breast tissue under the areola (puffy nipples). Some patients describe a history of steroid use in the past for weight training and muscle development. Since stopping the medication, they complain of residual breast fullness usually localized in the areola area or puffy nipples in addition to well-developed pectoralis major musculature, which contributes to the full chest. A number of patients report a history of obesity or major weight fluctuations that have taken a toll on their chests. With the prevalence of gastric bypass and lap band procedures, loose skin affecting the breasts with residual fullness in the area is a concern for many men seeking body contouring after massive weight loss. Oftentimes, men with gynecomastia describe a family history of male breast enlargement affecting brothers or fathers.
Other symptoms that may be associated with other conditions besides benign gynecomastia include unilateral breast enlargement, a distinct breast mass, skin changes, nipple discharge, and moderate to severe pain or tenderness. In these situations, other etiologies must be ruled out. These include the rare occurrence of mastitis (infection), breast cancer, and benign tumors.