Gynecomastia is a common condition in men and boys. The breasts swell and become abnormally large. All men and women have breast glands, but they are not noticeable in men, because they tend to be small and undeveloped.
Breast gland enlargement in males may affect newborns, boys during puberty, and older men.
By adulthood, 90 percent of cases are resolved. Later in life, the incidence increases again with age.
Gynecomastia does not mean that someone has extra fat from being overweight. It is caused by additional breast tissue. Doing exercise or losing weight will not reduce the breast tissue in gynecomastia.
Pseudogynecomastia is separate condition, where fat builds up in the breasts, possibly due to being overweight or obese.
Surgery for gynecomastia
The breast consists of glandular tissue, which is firm and dense, and fatty tissue, which is soft.
The ratio varies between individuals. A man with gynecomastia may have too much of both types of tissue.
Liposuction can remove excess fatty tissue. It involves inserting a small tube through a 3- to 4-millimeter incision.
Excision means cutting out tissue with a scalpel, to remove excess glandular tissue. This will normally leave a scar around the edge of the nipple.
If a major reduction in tissue and skin is necessary, the incision and the scar will be larger.
In some cases, both excision and liposuction will be used.
After surgery, the chest will be bruised and swollen, and the patient may have to wear an elastic pressure garment for 2 weeks to help reduce the swelling.
It will normally take about 6 weeks to return to a normal routine. Complications from surgery are rare. They include insufficient removal of breast tissue, uneven contour to the chest, and reduced sensation of one or both nipples.
Excision may carry a risk of a blood clot forming. This may require draining.
Treatment options for gynecomastia
Gynecomastia normally resolves without any treatment, but if there is an underlying condition, it may need treatment.
If the condition stems from a medication, the patient may need to switch to a different drug. If the patient is using the medication for a short time only, the condition will be temporary.
If the condition does not resolve within 2 years, or if it causes embarrassment, pain or tenderness, treatment may be necessary.
Treatment is rare. Options include breast reduction surgery or hormone therapy to block the effects of estrogens.
Medications for the treatment of gynecomastia
Tamoxifen is a drug that blocks the action of the female hormone estrogen in the body. It is used for treating and preventing breast cancer, but it can also reduce the symptoms of breast pain and breast enlargement in men.
Aromatase inhibitors, used for treating breast and ovarian cancer in post-menopausal women, may be used off-label to prevent or treat gynecomastia in males.
Testosterone replacement can treat gynecomastia in older men with low testosterone levels.
Causes of gynecomastia
A number of factors can lead to gynecomastia.
Gynecomastia can stem from an imbalance between the sex hormones testosterone and estrogen. Estrogen, the “female” hormone, makes breast tissue grow, while testosterone, the “male” hormone, stops estrogen from making breast tissue grow.
All males and females have both testosterone and estrogen, but testosterone occurs in higher proportions in males, while females have higher levels of estrogen.