Why Does My Gynecomastia Look Better When It’s Cold?Austin Gynecomastia Center

Gynecomastia is defined as the appearance of female-like breasts in a male. You know it when you see it. Instead of a flat chest contour with small nipple-areola complexes, the chest is round in appearance with more tissue than usual. This tissue is often accompanied by “puffy” nipple-areola complexes. I have heard many times in my practice that “my gynecomastia goes away when it’s cold.”

What explains this common observation?

It starts with gynecomastia and human anatomy. Gynecomastia consists of tissue that begins below the nipple-areola complexes and grows outward. This tissue proliferates from a hormone imbalance between estrogen and testosterone. This is most commonly seen at the time of a natural imbalance that occurs during puberty. It’s also common to see it nowadays in men taking testosterone replacement therapy (TRT) and performance supplements. This tissue that sits under the areolas causes expansion and herniation from the mass effect.

The nipple-areola complexes also have smooth muscle fibers spread throughout. These muscle fibers contract the skin when stimulated manually (think pinching the area) and by cold temperatures. When contracted, the puffy appearance of the nipples goes away—the area becomes flatter and smaller. Since puffy nipples is one of the most common complaints heard from gynecomastia patients, it’s a relief when this happens. Unfortunately, this would mean you have to constantly pinch and massage your chest area or move to a colder climate. Neither of these options are really going to make you happy.

How do you get rid of puffy nipples without surgery?

Unfortunately, there is no successful treatment of gynecomastia without a surgical procedure to remove the gynecomastia tissue, which is the cause of the entire problem. Exercise, weight loss, medications, non-surgical treatments like laser, CoolSculpting, anti-estrogens and other Internet snake oil options simply will not work.

How does surgical treatment of gynecomastia treat puffy nipples?

By removing ALL the gross gynecomastia tissue present, I am removing the mass of tissue that causes the prominence of the nipple-areola complex. The small muscle fibers that respond to cold are not removed. The nipple-areola complex then becomes smaller and flatter—precisely what gynecomastia patients want. Leaving some gynecomastia tissue behind so there is no collapse of the area, as many surgeons advocate, simply is not an option. A paper I published in 2022 clearly showed that complete tissue removal is possible and essential to achieve flatter, smaller nipple-areola complexes.