How do I know if I have gynecomastia?

Male patients often are concerned about the appearance of their chest and wonder if they have gynecomastia, the presence of breast tissue in a male.  One of the telltale signs of gynecomastia is the puffiness and projection of the areola.  The breast tissue, if present, is beneath the nipple and areola, the pigmented area around the nipple.  The male areola should be flat.  If the areola is not flat and this becomes more prominent in warm weather, this is a good indication of the presence of breast tissue underneath the areola.  Patients can often feel firm tissue behind the areola in the central portion of the chest.  This is the breast tissue.  

Patients also may notice that the size of the areola is larger than it should be.  This can also be an indication of the presence of breast tissue beneath the areola.  In summary, patients can often self-diagnose the presence of gynecomastia with the prominence and increased size of the areola.