GYNECOMASTIA

Gynecomastia (“man-boobs”) is the over-development of breast tissue in male patients. Patients can find this socially embarrassing and depressing with loss of self-confidence. Patients find that no matter how much they go to the gym or lose weight they cannot shift the breast tissue and alter their appearance satisfactorily.

What are the signs of gynecomastia?

Signs vary from a small amount of extra tissue around the nipples to more prominent breasts. It can affect one or both breasts. Sometimes, the breast tissue can be tender or painful, but this isn’t always the case.

What causes gynecomastia?

Gynecomastia can have several causes:

Hormone imbalance

Gynecomastia can be caused by an imbalance between the sex hormones testosterone and estrogen. Estrogen causes breast tissue to grow. While all men produce some estrogen, they usually have much higher levels of testosterone, which stops the estrogen from causing breast tissue to grow.

If the balance of hormones in the body changes, this can cause a man’s breasts to grow. Sometimes, the cause of this imbalance is unknown.

Obesity

Some growth in breast tissue is not due to extra body fat from being overweight, so losing weight or doing more exercise may not improve the condition. However, a common reason for gynecomastia is that being very overweight (obese) can increase levels of estrogen, which can cause breast tissue to grow.

Puberty

During puberty, boys’ hormone levels vary. If the level of testosterone drops, estrogen can cause breast tissue to grow. Many teenage boys have some degree of breast enlargement. Gynecomastia at puberty usually clears up as boys get older and their hormone levels become more stable.

Older age

As men get older, they produce less testosterone. Older men also tend to have more body fat, and this can cause more estrogen to be produced. These changes in hormone levels can lead to excess breast tissue growth.

Other causes

In rare cases, gynecomastia can be caused by:

- side effects of medication – such as anti-ulcer drugs or medication for heart disease

- illegal drugs – such as cannabis or anabolic steroids

- drinking too much alcohol

- a health abnormality – such as kidney failure or liver disease

- Klinefelter’s syndrome (a rare genetic disorder)

- lumps or infection in the testicles

Treatment for gynecomastia

There are two types of treatment for gynecomastia:

- surgery to remove the excess breast tissue

- medication to adjust a hormone imbalance

Breast Reduction Surgery:

The breast is made up of two main components, glandular tissue (firm and dense) and fatty tissue (soft). The ratio of glandular to fatty tissue in any breast varies from individual to individual and in gynecomastia there may be an excess of both. If there is predominantly a diffuse fatty enlargement of the breast, liposuction is the usual treatment. This involves sucking out the tissue through a small tube inserted via a 3-4mm incision (see information sheet on liposuction for more detail). If excess glandular tissue is the primary cause of breast enlargement, it may need to be excised (cut out) with a scalpel. This will leave a scar, usually around the nipple edge. This excision can be performed alone or in conjunction with liposuction. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more obvious scars. Most operations for gynecomastia take about 90 minutes to complete and are performed under general anesthesia, or in some cases, under local anesthesia with sedation.

Following the surgery the chest is swollen and bruised for a while and it can be difficult to assess the full effect of the operation. To help reduce swelling, patients are often instructed to wear an elastic pressure garment continuously for one or two weeks. It is advisable to refrain from exercise for about three weeks and, in general, it takes about six weeks before one can return to completely normal activities. The potential complications of the surgery are relatively rare. They include inadequate removal of breast tissue, an uneven contour to the chest and reduced nipple sensation.

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