Gynecomastia

What is gynecomastia?

Gynecomastia is the enlargement of breast tissues in young boys and men. The most common cause of gynecomastia is an imbalance between the estrogen and testosterone hormones. It can occur at any age but is more common in newborns and during puberty.

It can affect one or both breasts. Medical conditions like hyperthyroidism, cirrhosis, obesity, chronic kidney failure, etc., can cause gynecomastia. Certain medications can also cause gynecomastia.

Gynecomastia is a benign condition. It is asymptomatic but some patients have reported pain and discomfort in the breast(s). Since it can cause a certain amount of embarrassment, discomfort, and anxiety, patients may seek diagnostic evaluation and treatment. Some patients seek an early evaluation due to fear of breast cancer.

What are the symptoms of gynecomastia?

Some common symptoms include:

• The most common symptom of gynecomastia is an enlargement of the male breast. It is the enlargement of the glandular tissue of the breast and not fatty tissue.
• The enlargement or growth may affect both the breasts or only one breast.
• You may notice a lump or rubbery-firm breast growth under the nipples.
• The breast enlargement may be uneven or uniform compared to the location of the nipple.
• The growth may be more on one side of the breast than the other.
• You may feel some soreness or tenderness in the breasts.
• In adolescents, the condition may occur as a small bud in one or both breasts.
• Sensitivity in the nipples.

Gynecomastia versus breast cancer

Gynecomastia is a benign condition and it is important to differentiate it from male breast cancer. Breast cancer in men usually affects one of the breasts. The breast lump or tissues appear firm and hard to touch.

Symptoms of male breast cancer also include:

• Skin dimpling
• Nipple discharge
• Nipple retraction
• Enlargement of lymph nodes of the underarms.

Abscesses can also cause male breast enlargement. Patients may experience high fever and chills, pain and swelling, and redness in the skin.

Who can have gynecomastia?

Gynecomastia is common in:

Newborn babies

Gynecomastia is very common in newborns. This occurs due to the high level of estrogen in the mothers. Newborn babies may exhibit enlarged breasts or breast buds that normally go away in a few weeks.

Puberty

About 50 percent of teenage boys may develop some amount of breast enlargement due to fluctuating hormones. During this time, the estrogen levels go up and the testosterone falls. This may cause growth in breast tissues. The condition may last 6 months to 2 years after the hormone levels normalize.

Adult men

Two-thirds of adult men between the age of 50 to 80 may experience some degree of gynecomastia. At this age, there is less production of testosterone. Body fat accumulation may also trigger estrogen production and the growth of breast tissues.

Types of gynecomastia

Gynecomastia can be broadly classified into 5 types:

Glandular gynecomastia

This happens due to the presence of excess estrogen in the body. Fatty foods, medications, obesity can lead to excess production of estrogen. As the estrogen level goes up the testosterone level automatically comes down. As a result, there is excess growth of breast tissue in the male body.

Exercise and diet control can remove the excess tissues in the breasts. Some people undergo surgery to remove the excess fat and glandular tissues.

Fatty or pseudo-gynecomastia

Fatty or pseudo-gynecomastia is a result of excess weight gain. There is a difference between glandular and pseudo-gynecomastia. In glandular gynecomastia, there is an enlargement of breast tissues, whereas. In pseudo-gynecomastia, there is an accumulation of fat cells in the male breasts. It can occur in adult males and boys.

Chest exercises and diet regulation can help. If diet control and exercises do not help, breast reduction surgery is an alternative treatment.

Asymmetric/unilateral gynecomastia

A small percentage of males may develop unilateral or asymmetric gynecomastia. The condition occurs when only one male breast is enlarged. It may cause pain and swelling.

Male breast cancer is also a probable cause of asymmetric or unilateral gynecomastia.

Pubertal or adolescent gynecomastia

This is a hereditary condition and affects thirty to sixty percent of young boys. It generally occurs in the age group of 4 to 14 and resolves on its own. In severe cases, if the symptoms persist, young adults can seek a surgical intervention after the age of 18.

Adult gynecomastia

If the gynecomastia does not resolve during puberty, the symptoms may persist in adulthood. Medications and other medical problems may cause gynecomastia in adult men.

Treatment options for gynecomastia

Generally, gynecomastia happens during infancy or puberty and does not require any treatment. The symptoms in infancy may last for a few weeks and resolve on their own. In adolescents, it may take six months to two years. If the symptoms persist even after two years, adolescent males may seek treatment or breast surgery after consulting the parents. Breast surgery is usually done when the boy reaches the age of 18.

The treatment plan depends on:

• The age of the patient
• Overall health
• History of any diseases
• Patient’s response to medications or treatments
• Duration of the condition.

Treatment options:

• If your condition is due to any medication, your doctor will ask you to discontinue those medications.
• If the breast enlargement is a result of an underlying disease, then the disease will be treated.
• Hormone therapy to treat the imbalance between estrogen and testosterone.
• Breast reduction surgery if the condition does not improve with medications or hormonal therapy.

Diagnosis of gynecomastia

Based on your condition, your doctor will first send you to an endocrinologist to assess your hormone levels. The doctor will perform a physical examination to check the breast tissues, abdomen, and genitals as well.

In pubertal gynecomastia, the doctor may not suggest any treatment as the symptoms may resolve within a few months or two years.

In case of an abnormally large hard lump in the breast or nipple discharge, a biopsy may be ordered to rule out cancer, tumor, metastasis, or other conditions.

The doctor may ask for:

• Mammogram
• Chest x-ray
• MRI scan
• CT scan
• Ultrasound of the testicles
• Blood tests for hormonal imbalances and liver functions
• Urine tests
• Breast tissue sample for biopsy

Preparation for gynecomastia surgery

Patients undergoing gynecomastia surgery must prepare both physically and mentally.

Physical preparations

• Stop smoking, taking alcohol, or illicit drugs four weeks before the surgery.
• Avoid taking blood thinners, aspirin, and other medications for 2 weeks before the surgery. Consult your doctor about the medications to be taken.
• Inform the surgeon of any infection or illness that you have developed on the day of the surgery.
• Take a few days off from work.

Mental preparations

• Do not panic. Clear your doubts about the surgery.
• Keep your mind calm. Read good books, listen to music, watch movies, or go for a walk.
• Hydrate your body. Drink plenty of fluids.
• Ask a friend or a family member to stay with you on the day of the operation.
• Talk to your doctor about the expectations of surgery.
• Ask about possible risks of the surgery.
• Bring your laboratory results, medical history, and documents.
• Do not be late. Keep enough time for preparation before the surgery.

Procedures

A gynecomastia breast reduction surgery aims to contour the male breast. It removes excess fat or tissues and corrects other deformities in the breast, areola (dark skin around the nipple), or nipple. The surgical reduction of breasts is known as mammaplasty.

This can be done in three approaches:

• Liposuction
• Excision
• A combination of both

The surgeon may use general anesthesia or intravenous sedation.

Liposuction technique

A liposuction technique helps to remove the excess fatty tissues with the help of vacuum suction. Small incisions are made on the skin. A hollow tube called a cannula is inserted through the incisions to suck out the excess fat.

Excision technique

This technique removes excess skin and glandular tissues from the breast. It also helps to reposition the nipple, reduce the size of the areola, and to contour the breast.

Combination of liposuction technique and excision technique

Some surgeons approach a combination technique to remove the excess tissues and contour the breast.

When should you go for gynecomastia treatment?

Primary causes:

Sex hormone imbalance

The main reason for gynecomastia is an imbalance between the male and female sex hormones. During infancy and puberty, the estrogen levels may surge compared to the androgen levels. This is physiologic gynecomastia.

During puberty, hormone fluctuation may result in temporary elevation of the estrogen levels. The condition may last 6 to 2 years and generally resolves with time.

Infancy

Newborns may show short-term gynecomastia. This happens because the mother’s estrogen remains in the baby’s blood after birth. This elevates the estrogen level in the baby. The symptoms generally last for a few weeks.

Besides hormonal imbalances and puberty, there are other causes of gynecomastia such as:

Medical conditions

Malnutrition

A testosterone level in a person suffering from malnutrition drops while there is no change in the estrogen levels. This can cause gynecomastia. While recovering from malnutrition, refeeding can alter the hormones and cause gynecomastia.

Testicular disorder

If the testes or the male reproductive organs fail to produce enough testosterone and the estrogen levels are high, it may cause gynecomastia. Testicular cancer can also cause gynecomastia.

Chronic renal failure

Transient gynecomastia was noticed in patients who have undergone intermittent hemodialysis for chronic renal failure. Some patients also report symptoms of breast tenderness.

Thyroid problems

The thyroid gland regulates the growth hormones. If the thyroid is not working properly, it may cause gynecomastia.

Cancers

Cancers and tumors of the adrenal glands, pituitary, lungs and testicular tumors can cause gynecomastia.

Obesity

Obesity is a primary cause of gynecomastia. Increased weight elevates blood estrogen levels. It can cause excess growth of breast tissue. This causes gynecomastia.

Hepatic cirrhosis (end-stage liver disease)

The estrogen and testosterone ratio in patients suffering from liver cirrhosis plays a significant role in causing gynecomastia.

Trauma or injury

Blunt injury to the breast can trigger gynecomastia. It can also cause the progression of the symptoms of preexisting gynecomastia.

Genetic disorder

Klinefelter syndrome is a genetic condition when there are excess X chromosomes. As a result, the testicles are producing less testosterone. This may lead to gynecomastia. Testosterone treatment or cosmetic surgery is a good choice for treatment.

Certain medications may also cause gynecomastia.

Medications

• Anti-androgens used for treating prostate cancer
• HIV drugs
• Medications like metoclopramide (Reglan) used to empty stomachs
• Heart medications like Lanoxin
• Calcium channel blockers
• Certain antibiotics
• Anti-ulcer medications
• ACE inhibitors
• Anxiety drugs such as diazepam (Valium)
• Antidepressants

Other causes:

Substance abuse

Illegal drug abuse can cause gynecomastia. Teenagers or adults who use marijuana, heroin, alcohol, or anabolic steroids are at higher risks of developing gynecomastia.

Herbal supplements

Herbal supplements like tea tree oil, grape seed, lavender oil, ginseng, etc. can cause gynecomastia.

Surgery options

Once you decide to have the surgery, the surgeon will refer you to a hospital or a surgical facility. Sometimes the surgery can be done in the doctor’s clinic if he/she has all the surgical arrangements. Gynecomastia is generally a same-day operation. Patients can go home after the surgery. The decision to have surgery in a small facility or a big hospital depends on certain factors.

Small clinic

Pros

• Cheaper rates
• One-to-one patient service
• No need to wait for consultations

Cons

• Some clinics may lack proper surgical facilities
• Doctors must be highly qualified to do the surgery
• Very small staff to handle critical cases

Hospitals

Pros

• Adequate hospital staff
• Latest surgical facilities
• Efficient doctors to handle emergencies

Cons

• Cost is generally high
• Personalized care may not be possible due to a large number of patients
• Delay in consultation services

Cost of gynecomastia surgery

The cost of surgery depends on various aspects like:

• Grade of gynecomastia
• The type of surgical facility
• Expenses for the hospital stay
• Surgical charges

Post-op care and things to keep in mind

Consult your doctor about the recovery period. Patients can normally go to work after a week of rest. Ask your doctor about the aftercare instructions and when you can resume normal activities.

After the surgery:

• Your chest will be bandaged and you have to wear chest compression garments.
• For the first few days, you must take full rest. You can sit comfortably on the sofa or bed and watch television, read books, or have meals.
• Do not move your shoulder or arms vigorously.
• Avoid lifting arms above your head.
• Ask the surgeon about the care of surgical drains.
• Avoid rigorous exercises or strenuous activities for the first 2 to 3 weeks.
• Do not expose yourself to the sun directly for the first 6 weeks to avoid scarring of the incision site.

Risks from gynecomastia surgery

Probable risks from gynecomastia surgery include:

• Risks from anesthesia
• Hematoma
• Blood clots
• Irregularities in breast contouring or reshaping
• Asymmetrical breast
• Temporary sensitivity in breast and nipple
• Damage to blood vessels, tissues, nerves, muscles, or lungs
• Deep vein thrombosis
• Pulmonary complications
• Cardiac problems
• Fat necrosis
• Accumulation of fluid (seroma)
• Scarring
• Infections
• Delay in wound healing
• Reaction to glues, tapes, sutures for dressing the wound sites
• Need for another surgery due to poor surgical results

When to call your doctor?

Warning signs suggesting an emergency call to your doctor:

• A fever above 101.5 suggests an infection.
• Excessive bleeding from the incision sites.
• Warmth on the incision sites.
• Yellowish or greenish discharge from the wounds.
• Foul smell from the incisions.
• Excessive pain in the wounds cannot be managed by pain medications.
• Inflammation or firmness in the wounds
• Surgical drains not holding properly.

Best option

Gynecomastia surgery is a minimally-invasive procedure and recovery is much faster compared to traditional surgeries. The incision size is small and the surgeries usually do not leave any scars. Recovery from surgery may take one week.

Patients who want a consultation are often in a dilemma where to find the right doctor. Goficure is a Bangalore-based service provider in elective surgeries. They offer a complete package from handling consultations, appointments, hospital stays, to post-operative care. They have partnered with some of the best hospitals and surgeons and offer quality services at minimal prices.

Why should I go with goficure?

• Best services at affordable prices
• Top doctors and best hospitals
• Insurance coverage
• Personalized care by experts
• No compromises on patient care
• Aftercare facilities
• Transportation facilities for patients
• Counseling and mental support

References