Gynaecomastia (often referred to as ‘man boobs’ is the enlargement of male breast gland tissue ). It is not cancerous. Gynecomastia can develop in males of any age or weight but often arises around puberty as breast development is affected by hormonal changes. An accumulation of excess fat, and not breast gland tissue, is sometimes seen in obese men – this is not true gynaecomastia and is sometimes called pseudo gynaecomastia.
Gynaecomastia can appear as a rubbery or firm mass that starts from underneath the nipple and then spreads outwards over the breast area. It usually affects both breasts but often in different amounts so there is asymmetry, or it may only affect one breast. Sometimes the growing tissue can be painful or tender, and if this occurs then you should be examined by a doctor. Gynaecomastia can also result in significant psychological and social stress, leading to anxiety and embarrassment.
What causes gynecomastia?
There are many possible causes of gynecomastia, and these can be grouped into
- Physiological (the body normal functioning) causes
- Pharmacological (medication or drug-related) causes
- Pathological (disease) causes
Physiological gynaecomastia is caused by the normal hormone changes that occur during different stages of life. These changes result in an increase in the ratio of normal oestrogen hormones to testosterone hormones, with oestrogen encouraging breast tissue growth.
During infancy male babies can develop physiological gynaecomastia due to the transfer of oestrogen from the mother. This transfer stops after birth, so the gynaecomastia is temporary.
During puberty the maturing testes produce more oestrogen than testosterone, which can result in gynaecomastia.Usually this type of gynaecomastia goes away spontaneously,but sometimes it can persist longer term.
During older age there is a gradual reduction in testosterone production, resulting in an increased oestrogen to testosterone ratio,which can encourage the growth of breast tissue.
Pharmacological gynaecomastia is caused by medications or drugs that affect the ratio of oestrogen and testosterone through multiple different ways. Some of these medications include anabolic steroids, heart medications, or drugs of abuse such as marijuana or alcohol. While stopping the offending drug will usually result in the gynaecomastia going away.
Pathological gynaecomastia is caused by multiple different diseases or conditions that affect the ratio of oestrogen to testosterone. These conditions are quite rare but may include genetic problems, chronic diseases (especially kidney and liver disease), and tumours in the testis or adrenal gland.
- Grade I: Minor enlargement, no skin excess
- Grade II: Moderate enlargement, no skin excess
- Grade III: Moderate enlargement, skin excess
- Grade IV: Marked enlargement, skin excess
Medical treatment of gynecomastia is most effective when done within the first two years after the start of male breast enlargement.
Selective estrogen receptor modulators(SERMs) such as tamoxifen, raloxifene, and clomifene may be beneficial in the treatment of gynecomastia but are not approved by the Food and Drug Administration for use in gynecomastia. Tamoxifen may be used for painful gynecomastia in adults.
- Subcutaneous mastectomy
- Liposuction-assisted mastectomy
- Laser-assisted liposuction
- Laser-lipolysis without liposuction.
Complications of mastectomy may include hematoma, surgical wound infection, breast asymmetry, changes in sensation in the breast, necrosis of the areola or nipple, seroma, noticeable or painful scars, and contour deformities.