Our physique is largely dictated by our lifestyle is a widely accepted and proven fact. One of the many effects that the lifestyle changes of modern life have is the enlargement of the breast tissues in men. This enlargement of breasts tissues in men is known as gynaecomastia. While this development might simply be because of development of fatty tissues, some people also experience this change because of certain other underlying causative factors.

What is Gynaecomastia?

What is Gynaecomastia?

Gynaecomastia can be simply defined as the condition wherein there is a benign or non-cancerous increase in the amplitude of the breast tissues in men. New born babies, adolescent boys, older and obese men often experience such a condition when there is a certain increase in the size of their breasts. While it is natural for new born babies and adolescent boys to experience gynaecomastia due to the maternal hormones and the onset of puberty respectively, it might not be that simple for other people. Though, Gynaecomastia is mostly benign and painless, some people might however, suffer from Gynaecomastia due to cancerous growth leading to painful experience.

Signs and Symptoms of Gynaecomastia

There are certain signs and symptoms that one could look out for in case the size of the breasts start increasing in order to ascertain the condition to be gynaecomastia:

  • The primary symptom of gynaecomastia is the enlargement of the glandular breast tissue as opposed to the fatty tissues, which leads to pseudo-gynaecomastia, in the male body. The enlarged breast area near the nipple may feel firm or rubbery.
  • Though gynaecomastia is generally bilateral, affecting both breasts, cases of unilateral gynaecomastia, involving either breast have also been reported.
  • Though the condition is generally painless, a feeling of tenderness and sensitivity might be present.
  • Males with prolactin secreting tumour might also observe milky discharge from the nipples, though it is not a typical symptom of the condition.
  • Gynaecomastia may also manifest itself in the increased diameter of the aerola or an asymmetry in the tissues of the chest.

Though gynaecomastia is benign by nature, medical interference is necessary to assure the growth to be non-cancerous. Cancerous growth of the breast tissue is generally restricted to one side of the breast. However, it might not be restricted to the area of the nipple.

Causes of Gynaecomastia

The condition of Gynaecomastia or more simply the developing of breasts in men may occur due to one or more than one of the following reasons-

  • Hormonal Imbalance: The balance of oestrogen and testosterone, the two sex hormones is vital in all human beings. While oestrogen is responsible for the development of breasts in the female body, testosterone, on the other hand, is responsible for the development of beard, moustaches and the other such biological features in a male body. The oestrogen level in men is dominated by the testosterone levels, thereby, inhibiting the growth of breast tissues. However, an imbalance in these hormones, where the level of oestrogen becomes more than testosterone, results in the growth of breast tissues leading to gynaecomastia.
  • Obesity: Obesity often leads to an increase in the oestrogen levels in the human body, resulting in the growth of breast tissues in men. This can finally lead to gynaecomastia.
  • Puberty as a Cause of Gynaecomastia: The levels of oestrogen and testosterone might often change during puberty- the oestrogen level might increase, thereby leading to gynaecomastia. This condition is generally resolved without medical interference within a couple of years. However, 25% of gynaecomastia in adolescent boys needs medical attention for resolution.
  • Old Age Can Cause Gynaecomastia: The levels of testosterone might go down as men become older because of reduced production of the hormone in the body. Older men also tend to accumulate more fat in their system. All of these reasons might lead to the development of breast tissues in older men, thereby leading to gynaecomastia.
  • Maternal Hormones as a Cause of Gynaecomastia in New Born Babies: A baby in the womb is connected to the mother by means of the placenta. Often, oestrogen passes through the placenta from the mother into the baby's body. Thus, a new born baby might be affected by gynaecomastia. However, the condition is likely to be resolved within a few weeks post birth.

Apart from the afore-mentioned causes, gynaecomastia can also be caused by certain other factors, including-

  • Over-consumption of alcohol
  • Certain health conditions, such as, kidney and liver diseases
  • As side effects of certain medications, such as, medications for heart diseases, anti-ulcer medications and the like.
  • Genetic disorders such as Klinefelter's Syndrome
  • Use of drugs such as anabolic steroids or cannabis
  • Issues in the testicles such as development of lumps.

Diagnosis of Gynaecomastia

Diagnosis of gynaecomastia can be generally made by the physician without any special tests. However, patients might be suffering from other conditions such as pseudo-gynaecomastia and breast cancer which have symptoms similar to gynaecomastia.

  • Mammography to Diagnose Gynaecomastia. This is done in order to ascertain that the enlargement of the glandular tissues in the chest area of males is not cancerous in nature.
  • Core Biopsy or FNAC, that is, Fine Needle Aspiration Cytology of the breast tissue might also be needed in order to find out if the affected person is suffering from the proliferation and enlargement of the ducts, swelling and inflammation around the ducts and connective tissue and growth of fibroblasts.

Along with the above tests, patients might also need to undergo certain blood tests to test the renal functions and hormonal profile.

Treatment of Gynaecomastia

A majority of the cases of gynaecomastia do not need any medical attention. However, a further increase in the size of the breasts and a sensation of pain might call for medical assistance. While certain changes in lifestyle can resolve the condition in certain cases, the same cannot be said for all other situations. Gynaecomastia can be treated in the following ways-

  • Medications to Treat Gynaecomastia: Danazol,Tamoxifen and Aromatase inhibitors are the three most effective medications prescribed for the treatment of gynaecomastia.
    • Danazol works by reducing the pain in the breast and also the levels of oestrogen produced in the testicles of the male body, thereby, reducing the size of the breasts.
    • Patients might experience certain side effects such as, acne breakout, weight gain and the like.
    • Though used for treating breast cancer, recent studies have proved Tamoxifen to be effective in treating gynaecomastia as well. It works by reducing the breast size in the male body and has several side effects such as, upset stomach and nausea.
    • Aromatase inhibitors are generally prescribed in cases of gynaecomastia occurring during puberty and include side effects such as, pain in the joints and a reduction in the bone strength.
  • Surgical Procedures to Treat Gynaecomastia: Surgical procedures are likely to be suggested if no improvement is seen in the condition of people affected by gynaecomastia even after changes in lifestyle and use of medications. Such procedures are likely to include subcutaneous mastectomy, laser-assisted liposuction, laser-lipolysis without going for liposuction and liposuction assisted mastectomy. The procedure might be accompanied by certain complications such as hematoma, breast asymmetry, necrosis in the aerola and the like.

Prognosis of Gynaecomastia

Gynaecomastia or the development of breast tissues in men is generally seen as a benign condition and can be treated completely if the underlying causative factors can be identified correctly and treatment is started before the onset of fibrosis of breast tissues. This condition is more commonly seen affecting older men within the age group of 41 and above and adolescent boys of 12-18 years of age. Though the condition is generally benign, it might be a source of psychological distress, especially among adolescent boys.

Conclusion

The enlargement of breast tissues among men can be seen as being one of the most common issues these days. Though a majority of the cases are benign in nature, about 1% of them may turn out be cancerous and painful. However, with proper medical attention and certain changes in the lifestyle one could observe positive changes.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: March 10, 2017

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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