Like starting to shave, the lowering of one\'s voice, or developing an Adam\'s Apple, a flat and strong looking chest is seen as a sign of masculinity. It is humiliating to have a chest that looks even the slightest bit feminine. Many women seek breast augmentation because they say, \"I look like a boy and just want to feel feminine.\" And though men never make the opposite statement, probably because the words are too hard to say, it is probably in the back of their minds. As shy as some flat-chested women are about men seeing their chest naked, they tend not to have the same level of shame or humiliation as do men with gynecomastia. It is very common that even men with the mildest forms of gynecomastia never want to take their shirt off, wear loose clothes over a tight undershirt, and spend time in front of a mirror pushing their chest back to make it look flatter.

Men are also much more hesitant than women to undergo plastic surgery in general, and gynecomastia surgery in particular. Perhaps they still believe in stereotypes that have long since been abandoned about plastic surgery not really being for men. Or they remain in some degree of denial about their gynecomastia, privately hiding their embarrassment, but not wanting to look the problem squarely in the eye.

Many gynecomastia patients are men who never lost the extra bit of puffiness they had on their chest during puberty. They may be fit or work out, but no matter what they do, they cannot see the outline of their pecs. Others may have taken steroids for weight lifting, and these steroids can cause a rapid growth of the breast tissue. In the case of weight lifting, usually there is a very firm marble or walnut that they can feel. Many others suffer from gynecomastia as a side-effect of prescription medications or recreational drugs.

There are two methods for treating gynecomastia: liposuction and excision. In the pre-liposuction era, the only thing to do was to cut out the tissue (excision), usually using a small incision around about half the diameter of the areola. This worked great when there was a small and well-demarcated and circumscribed gynecomastia mass under the areola. But it didn\'t work well when there was fat spread throughout the chest. Liposuction is ideal for the reduction of fat, because fat is soft and is easily removed through the liposuction instrument (much like a straw.) However, firm and glandular gynecomastia issue cannot be removed by liposuction; it needs to be excised.