Gynecomastia Review

What is gynecomastia?

Gynecomastia is a benign enlargement of the male breast. The masculine appearance of the chest is replaced by what looks like small or sometimes even fully developed “woman-like” breasts. The enlargement of the breast in gynecomastia is caused by growth or proliferation of the glandular component of the breast much like the changes seen in a woman’s breast as she passes through puberty.

Enlargement of the breast caused by too much fat (ie. not primarily glandular enlargement) is called pseudogynecomastia.

Despite the different causes, both lead to breast enlargement and both are amenable to cosmetic improvement.

What causes it?

Gynecomastia is caused by a hormonal imbalance in the body that stimulates the dormant breast tissue in a man’s breast to enlarge. It can occur when certain hormones are elevated in the bloodstream, when others are low or when the breast tissue’s sensitivity to the hormones is increased. There are many drugs, remedies and supplements that are associated with gynecomastia as well. Drug abuse, especially with anabolic steroids, marijuana, alcohol and opioids can also lead to breast enlargement.

During puberty, gynecomastia is quite common and is called physiologic pubertal gynecomastia. It usually lasts around 6 months then resolves over an 18 month period in most cases. It can persist however in approximately 5% of cases. This appears to be the main cause of gynecomasia of young men in their late teens or twenties who present for evaluation of enlarged breast tissue.

Another peak occurs in older men, when it may occur in 25-65% of men. The reasons for this are multiple and related to the changes taking place with age. Older men are also more likely to take medications associated with gynecomastia than are younger men.

The top three causes of gynecomastia – about 25% of cases each – are persistent physiologic pubertal gynecomastia, drugs and gynecomastia associated with no known abnormality.

How is it evaluated?

Patients with gynecomastia are first evaluated by an endocrinologist – a specialist trained in, among other things, the complex relationship of hormones within the body. Your evaluation will consist of a detailed history, physical examination and some specific tests.

The detailed history will look for clues related to the various causes of gynecomastia as well as questions related to the growth of your breasts – when and how quickly it developed, the duration of the enlargement, is it on one side or both, is there pain associated, is there a family history of gynecomastia and many others.

You physical exam will include a detailed exam of your breasts as well as a general examination, again searching for clues as to the source of the hormonal imbalance. Although generally found in both breasts, gynecomastia can be seen in one breast only.

Further investigations are determined on a case by case basis but may include a mammogram or ultrasound to investigate your breast tissue further and a series of blood tests. The vast majority of blood tests come back negative in patients undergoing investigation of gynecomastia. According to a recent review of gynecomastia...

“The likelihood of discovering a pathologic abnormality is low in patients with long-standing asymptomatic gynecomastia.”

New England Journal of Medicine
Glen B. Braunstein, MD, 357:12, 2007.

The vast majority of gynecomastia causes are benign in nature. Once your endocrinologist has confirmed this, you can then seek cosmetic improvement/correction of the situation.

Should I get an appointment with an endocrinologist?

As you’ve just read, the endocrinologist is the specialist best suited to properly investigate gynecomastia. Certainly any patient with recent enlargement of their breasts, if this enlargement is associated with pain, a mass in your breast, deformity or if only one breast enlarges, should see an endocrinologist first.

There are many patients who simply have had enlarged breasts for many years or sometimes their entire lives. These cases are not associated with any underlying disease and a preoperative visit with an endocrinologist is not required.

If you are in doubt or if you have any questions about you condition, there’s no harm in seeing either an endocrinologist or myself first. Either way, you’ll learn more about your condition and if a detailed investigation is required before cosmetic improvement is considered.

How is gynecomastia treated?

If the gynecomastia has been present for more than 1 year, there is little chance it will regress to any degree with or without treatment. Medical therapy is directed at the cause and only seems to have some benefit when instituted during the time the breast is enlarging.

If the gynecomastia has been present for over a year or in cases of longstanding breast enlargement in patients who are trouble by their appearance, there are surgical procedures designed to remove the unwanted tissue with minimal scarring. This option generally results in a return to a more normal masculine chest.

Ok, Just Give Me the Facts

What is it?

• A condition where a man’s breast grows too big

• Usually both sides, sometimes only one

• is excess fat or excess gland or a combination of the two

Causes

• Most cases are benign in nature and do not require an extensive workup

Treatment

• Liposuction in most cases, sometimes combined with a minor excision of breast tissue

• More extensive surgery to remove excess skin and fat in cases of weight loss or patients with very large gynecomastia

If you have any other questions regarding gynecosmastia please contact our office to set up a consultation.