By Doctor Hugues Hennebert
- Gynecomastia is a benign phenomenon but frequently with a psychological negative impact.
- Gynecomastia consists in men’s breast hypertrophy. How does it happen?
When to see a Doctor? How to treat it?
Everyone has a sexual hormonal production. Commonly it’s testosterone for male and oestrogen for female.
The hormones testosterone and oestrogen control the development and maintenance of sex characteristics in both men and women. Testosterone controls male traits, such as muscle mass and body hair. Oestrogen controls female traits, including the growth of breasts.
How does it happen?
In physiological conditions the mammary gland will not develop for male. Gland will remain immature.
Gynecomastia is a swelling of the breast tissue in boys or men, caused by an imbalance of the oestrogen and testosterone. Gynecomastia can affect one or both breasts, sometimes unevenly.
Gynecomastia is different from adipomastia. In adipomastia, patients have an excess of fat, often associated with overweight.
In many cases, both can be associated.
Usually, Gynecomastia begins around 12 years old at the time of puberty.
Gynecomastia may go away on its own at the end of puberty.
But sometimes, fibrosis appears and glandular tissue will not decrease.
Breast takes a definitive shape that can be psychologically very difficult to support for a teenager or a young adult.
It can induce a loss of self-confidence, a fear of slim clothes, and self-limitation of pools, beaches, and swimming activities. In those cases, medication or surgery may help.
When to see a Doctor?
See your doctor if you have swelling, tenderness, pain, or nipple discharge in one or both breasts.
You may feel embarrassed to talk about gynecomastia with the people you care about. But explaining your situation to a Doctor and asking for help will likely strengthen your relationships and reduce stress.
The medical assessment will try to find a cause for gynecomastia.
Gynecomastia is triggered by a decrease in the amount of the testosterone hormone compared to oestrogen. The cause of this decrease can be a condition that reduces testosterone, block the effects of testosterone, or increases the oestrogen level. Several things can upset the hormone balance.
Most common natural causes is a change of hormone balance. Male oestrogen levels that are too high or are out of balance with testosterone levels can cause gynecomastia.
- Gynecomastia in infants. More than half of male infants are born with enlarged breasts due to the effect of their mother’s oestrogen. Generally, the swollen breast tissue goes away within a few weeks after birth.
- Gynecomastia during puberty. Gynecomastia caused by hormone changes during puberty is relatively common. In most cases, the swollen breast tissue will go away without treatment within six months to two years.
- Gynecomastia in men. The prevalence of gynecomastia peaks again between 50 and 80 years old. At least 1out of every 4 men in this age group is affected.
Most frequently, there is no specific cause to explain gynecomastia and the doctor’s diagnosis is idiopathic gynecomastia.
But there are also many pathological reasons that can induce gynecomastia like medication, street drug, alcohol, or health condition affecting the normal balance of hormones.
Gynecomastia has few physical complications but it is mainly responsible for psychological or emotional problems caused by appearance.
Your doctor will ask you questions about your medical and drug history, and what health conditions run in your family. The doctor will also do a physical examination that may include careful evaluation of your breast tissue.
Initial tests to determine the cause of your gynecomastia may include blood tests and mammograms.
Your doctor will want to be sure that your breast swelling is actually gynecomastia and not another condition that can cause similar symptoms including:
- Fatty breast tissue (adipomastia). Some men and boys have chest fat that looks like gynecomastia. This is called false gynecomastia (pseudo gynecomastia), and it is not the same as gynecomastia.
- Breast cancer. This is uncommon in men, but can occur. Enlargement of one breast or the presence of a firm nodule raises the concern for male breast cancer.
- A breast abscess (mastitis). This is an infection of the breast tissue.
How to treat it?
Talking with a doctor can help avoiding anxiety and depression caused by gynecomastia. It can also help to communicate with your partner or family members so that they understand what you are going through.
There are a few factors you can control that may reduce the risk of gynecomastia:
- Don’t use illegal drugs. Examples include steroids and androgens, amphetamines, heroin, and marijuana.
- Avoid alcohol. Don’t drink alcohol, or drink in moderation.
- Review your medication. If you are taking medication known to cause gynecomastia, ask your doctor if there are other choices.
Some cases of gynecomastia regress over time without treatment. However, if gynecomastia is caused by an underlying condition, such as hypogonadism, malnutrition or cirrhosis, that condition may need treatment. If you are taking medications that can cause gynecomastia, your doctor may recommend stopping them or change them for another medication.
In adolescents with no apparent cause of gynecomastia, the doctor may recommend periodic re-evaluations every three to six months to see if the condition improves on its own. Gynecomastia often goes away without treatment in less than two years. However, treatment may be necessary if gynecomastia does not decrease or if it causes significant pain, tenderness or embarrassment.
At the early stage of development, medical treatment with pills or with male hormone cream can be effective.
When it is too late, surgical removal is very efficient and quite painless.
Surgery can be a day-case or a short stay procedure, depending of the amount of breast to remove. Patients have to wear an elastic bandage for one month but could have a shower after 2 days. They can go back to the swimming pool only after one month.
When there is some fat associated, an associated liposuction could reshape the body.
Surgery is very efficient to remove excess breast tissue
For a man, enlarged breasts can be stressful and embarrassing. Gynecomastia can be difficult to hide and a challenge to romantic relationships. During puberty, gynecomastia can make boys a target for teasing from peers. It can make activities such as swimming or changing in the locker room traumatic.
Whatever your age, you may feel like your body has betrayed you and you may feel unhappy with yourself. These feelings are normal.
If you still have significant bothersome breast enlargement despite initial treatment or observation, your doctor may advise surgery.
Two main gynecomastia surgery options are:
- Liposuction. This surgery removes breast fat, but not the breast gland tissue itself.
- Mastectomy. This surgery removes the breast gland tissue. The surgery is often done by small incisions. When there is an important associated excess of skin, bigger incisions may be necessary.
After surgery you will need to wear elastic contention
The necessary time needed to recover from surgery is proportional to the amount of fat excess or breast removed. After surgery, you will observe swelling and bruising in the treated areas. Pain can vary from one patient to another, but it is usually mild, due to the use of very thin cannulas. Fatigue is common in the first few post-operative days, especially after large gynecomastia.
Techniques, products and monitoring methods have progressed considerably over the last twenty years, offering optimal safety, especially when the operation is elective and the patient is in good general health.
You can be assured that when procedure is performed by a qualified Plastic Surgeon, he will have the experience and skill required to avoid complications, or to treat them successfully if necessary.
Dr Hugues HENNEBERT, Plastic surgeon.