Table of contents
- What is Gynecomastia?
- What are Pseudogynecomas?
- Gynecomastia In Infants
- Gynecomastia During Puberty
- What are the risk factors causing gynecomastia?
- How is gynecomastia diagnosed?
- How is gynecomastia treated?
- What are the most common complications associated with gynecomastia?
- Can gynecomastia be prevented?
Gynecomastia is an increase (enlargement or swelling) in breast tissue size for males. It is typically due to high estrogen levels, which are excessive or not in the range of testosterone levels.
What is Gynecomastia?
Gynecomastia is an ailment in which male breast tissue overdevelops and may grow in a different way. This is caused as a result of hormonal imbalances in the body that is responsible for sexual characteristics. This usually occurs during puberty or adolescence, and although it can occur in babies and older men, it is more prevalent in teen boys. It is estimated to affect over 40-60% of teen boys, affects one or both breasts, and it could be quite embarrassing to talk about because of the societal stigma. They may experience slight pain. This could go away without treatment. 1 in 4 men between ages 50 and 69 develop this condition, with about 60%- 90% in children, 50%-60% in adolescents, and 70% in older men. It could be possible for one to have most symptoms of gynecomastia but have pseudo-gynecomastia.
What are Pseudogynecomas?
Pseudogynecoma is a condition where there is an accumulation of excess fatty tissue around the breast, giving it a puffy and swollen look. This can be improved with exercise, and any means of weight loss, although in some cases, it may be futile, as the fat may be resistant to the weight loss.
Gynecomastia In Infants
Gynecomastia occurs in infants due to the mother’s estrogen effect; hence the infant’s breast is swollen. It goes away after two to three weeks after birth.
Gynecomastia During Puberty
This is the prevalent type of gynecomastia. It occurs due to the low testosterone level and its activity in the male. The male produces a small amount of estrogen, but when the estrogen level increases above average, resulting in an enlarged breast. In most cases, this will disappear within 6 months without any treatment.
The causes of gynecomastia vary, but the primary cause is a hormonal imbalance of estrogen and testosterone, that is, whenever there is a decrease in testosterone and an increase in estrogen levels.
Other causes include:
- Genetic mutation
- Medications that contain steroids for bodybuilding
- Medications for the heart and stomach
- Any conditions that reduce the activity of testosterone
- Sometimes mental conditions also
- Alcohol, marijuana, and heroin could cause it.
- Underlying health conditions such as hypogonadism, hyperthyroidism, kidney failure, liver conditions, etc.
- Malnutrition and poor diet
- Cirrhosis of the liver,
- Chronic kidney failure,
- Disorders of the testes (male sex organs), including infection, trauma, or inborn disorders,
- Testicular cancer,
- Anti-androgen treatments for prostate cancer and.
What are the risk factors causing gynecomastia?
The risk factors include:
- Increase in age
- Bodybuilding drugs that contain steroid
- Underlying diseases
The symptoms of gynecomastia include:
- Pains and tenderness of the nipple
- Increase in swelling of the breast
- A rubbery lump feels on the nipple when touched.
- Pain or tenderness.
- Nipple discharge in one or both breasts.
How is gynecomastia diagnosed?
The diagnosis of gynecomastia is made through some tests. They are listed below:
- Medical and drug history of the patient
- Family history
- Physical exam: During the physical examination, the doctor will examine breast tissue, abdomen, and genitals.
- Blood tests are done to check hormone levels.
- Mammograms and breast ultrasonography- these tests are done to view the detailed images of the breast growth and examine unusual growth and changes in the breast tissue.
How is gynecomastia treated?
Most cases of gynecomastia resolve over some time without treatment. But the underlying condition that causes the disorder may be treated. Underlying causes of gynecomastia may be hypogonadism, malnutrition, or cirrhosis. In situations with no apparent cause other than normal hormone changes, the doctor may recommend periodic re-evaluations every 3 to 6 months to see if they will improve on their own. The doctor may recommend discontinuing any medication that promotes gynecomastia or substituting another medication. Gynecomastia often goes away without treatment in less than two years. Treatment may be necessary if its symptoms persist.
Medication used to treat breast cancer and other conditions may be of help to some men with gynecomastia. Such medications include:
- Danazol. A synthetic derivative of testosterone
- Tamoxifen (Sottamox)
- Clomiphene. It can be taken for up to 6 months.
- Aromatase inhibitors such as anastrozole (Arimidex)
- Testosterone replacement has been effective in older men with low levels of testosterone but not effective for men with normal levels of the male hormone.
The doctor may recommend surgical procedures if gynecomastia does not respond to initial treatment. Two surgical options for gynecomastia are:
- Liposuction. This type removes the breast fat, not the breast gland tissue itself.
- Mastectomy: It removes the breast gland tissue. The surgery is always done using only small incisions. It has recovery time.
The surgery involves the surgical removal of excess fat. It usually involves liposuction of excess fat. An incision is made in the margin of the nipple after the proper examination has been made, and the presence of gynecomastia has been confirmed.
While preparing for surgery,
- Avoid medications that might cause bleeding during surgery
- Avoiding smoking while waiting for surgery
- Improve diet and nutrition
- The patient will be administered anesthesia or oral sedation
- Then an incision is made in the breast region, and the excess fat is removed
- a drain is used to reduce the chance of fluid collections
- a compression vest is used to reduce the pain and reduce swelling
- The patient is advised to stay nil-per-oral (avoid drinking) after surgery
- The patient will be given medications for pain relief.
- The patient is advised to take rest after the surgery.
Recovery after Surgery
Cases involving liposuction have a higher recovery rate as the patient can recover within days. When surgery is used to remove the fat, it takes approximately two to four weeks for complete healing.
What are the most common complications associated with gynecomastia?
The complications could result in psychological and emotional conditions due to societal stigma.
When To See The Doctor
One should see the doctor when:
- The swellings around the breast increases
- Increase in pains around the nipple
- Nipple discharge.
Can gynecomastia be prevented?
It can be prevented by:
- Avoiding the risk of medications that contain steroids, androgens, etc.,
- Avoid alcohol
- Also, avoid smoking
Gynecomastia caused by hormone change during puberty is relatively common. Generally, the swollen breast tissue goes away on its own within 2 or 3 weeks after birth. In most cases, the swollen breast tissue will go away without treatment within six months to 2 years.
On palpation (touch), it feels like a rubbery lump under the nipple affecting one or both breasts. Indicative appearance includes a resemblance to that of a woman’s breast.
Treatment of Gynecomastia can be done using medicines like the drug raloxifene (Evista) as well as tamoxifen (Sottamox).
Grade I: Small enlargement without excess skin.
Grade II: Moderate enlargement without excess skin.
Grade III: Moderate enlargement with minor skin excess.
Grade IV: Marked enlargement with excess skin mimicking female breast ptosis.
Picture Courtesy: shutterstock
The main symptom of gynecomastia is enlarged breasts. The breasts may be tender as well. A person may feel a slight bump or lump behind the nipple.
Picture Courtesy: clinic.co
Gynecomastia is the most common male breast disorder found worldwide. It affects between 50-65% of boys worldwide .