 So this is a demonstration of gynecomastia, which we have designated out before I talk about the gynecomastia This is the right side and this is the left side. Let me tell you why this patient had gynecomastia If you look here, this is his liver He had a microdenodinous erotic liver Most probably alcoholic also referred to as larynx erosics. He had very prominent Engorged Esophageal varices. This is the esophageal gastric junction and we can see the dilated veins Submucosal veins, the esophageal varices inside as well as outside and he had a very dilated left gastric vein So he had cirrhosis with portal hypertension and he also had Testicular atrophy. His testis were small and we can see them here. So therefore this patient had Cirrhosis with portal hypertension with esophageal varices and we know that cirrhosis is accompanied by Gynecomastia in quite a few percentage of cases. So let's take a look at, we decided to dissect out the Gynecomastia to see how it looks like So this is the right side. This was a larger gynecomastia and we made a circum-aeroline incision and we removed the gynecomastia So this is the gynecomastia that we have removed here It was completely covered by fat anteriorly which we have removed and it was covered by fat posteriorly which we have retained here So this is the Gynecomastia itself with the nipple and the aereola attached to it. We notice that it is well encapsulated On feeling it, it feels very firm in texture almost like skittish capsule When we cut it open We found that the interior had a very coarse gritty sensation But there were no distinct low-views as we see in a female breast We turned it around and we split it open in many places And we found that extending from the surface capsule there were indistinct Partial septae which were going inside and dividing the gynecomastia into Incomplete indistinct low-views which were partially filled with fat So this is what we noticed about the gynecomastia Well circumscribed, very firm, no clear low-views on the right side Now let's take a look at the left side This was the gynecomastia which we have excised with the surrounding skate And let's lift it up And while lifting it up, we notice that this also had a similar external It was covered by fat on its outer surface It was covered by fat on its inner surface on which it was resting It was resting on the pectoralis fascia and there was retro-memory space And on splitting it open we notice that it had the same gritty texture This is the appearance of the gynecomastia on its internal side No distinct low-views but there were spaces filled with fat So, and on the retro-memory surface also we had similar We had partial septae dividing it into incomplete low-views And filled with a little bit of fat So what are the differences between a gynecomastia and a typical section of a female breast? In a female breast, there will be a skin, then there will be a layer of fat Then there will be a well-defined capsule And when we remove the capsule, there will be yet another layer of fat And when we remove the second layer of fat, we will see a mammary lobules Which will be collections of alveoli And in between the lobules and alveoli also there will be fat But here we see that there is only a layer of fat outside And on the retro-memory surface And though it is well encapsulated, there is no distinct lobules and alveoli Because this is not the secreting organ in the case of males And the surface is very hard It is almost cartilaginous and thin This is how it feels when we have in a female breast What is known as a skierus carcinoma This also feels something like skierus carcinoma And this is what we see in the gynecomastia of a male So we thought we would make this dissection Just to demonstrate how a gynecomastia in a male looks like and feels like And how is the architecture of a gynecomastia different from that of a female So thank you very much for watching If you have any questions or comments Please put them in the comment section below Dr. Sanjay Sanyal signing out Have a nice day