146 Gynaecomastia
Salient features
Examination
• Palpate to confirm the presence of glandular tissue (before palpation ask the patient to lie flat on his back with his hands clasped beneath his head). Using the separated thumb and forefinger, slowly bring the fingers together from either side of the breast. In patients with true gynaecomastia, a rubbery or firm mound of tissue that is concentric with the nipple–areolar complex is felt, whereas in patients with pseudogynaecomastia, no such disk of tissue is felt.
• Tell the examiner that you would like to look for stigmata of cirrhosis.
