Although pseudogynecomastia outwardly resembles real gynecomastia, is actually has no medical reason for being there. How this differs from genuine gynecomastia is that true gyencomastia has myriad reasons for occurring; some natural and some medically induced, while pseudogynecomastia is linked to the patient's weight alone.
As with all cosmetic surgery, results are most gratifying when expectations are realistic.