Gynecomastia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 9, 2016
StartDiseasesGynecomastia

Gynecomastia is a common ailment in a man's endocrine system. It is non-cancerous and happens temporarily to most males at some point during the course of their life, especially during infancy or puberty.

Contents

Definition & Facts

About 70% of adolescent boys experience a small degree of breast development during puberty. The over-development of the breast tissue in males is called gynecomastia. This occurs in response to an excess of estrogen, or a deficiency in testosterone. Due to these factors, the breasts' glandular tissues swell and create an enlarged breast. Gynecomastia occurs in males of all ranges from babies to teenagers and older men.

Symptoms & Complaints

The typical symptom of gynecomastia is the enlargement of male breasts. This includes soft and compressible chest tissue located under the skin that is underneath the areolas. It is possible for this to happen in a single breast, or both breasts together.

This tissue becomes mobile and lumped together, not creating a dimpling appearance in the skin. It is also not typical to have a discharge from the affected nipple. A common symptom of gynecomastia is an increase in the size of the areola as well as asymmetry of the chest tissue.

Causes

Gynecomastia is caused by an increase of estrogens or a decrease in androgens, which results in an altered ratio of hormones. The cause of this happening is unknown in about 25% of cases, but there are certain health conditions and medications that can be a factor. In newborns, breast enlargement in males is caused by the estrogen being passed on from the mother during birth. This is very common in baby boys. The newborn breast buds typically gradually go away by the time the baby is 6 months old, but in some babies, they last longer.

As with infants, breast buds are also common during puberty. These buds can last for up to 2 years, however they typically go away within a single year. Once a male hits his teen years, gynecomastia can be caused by hormonal changes that come along with puberty. This is very common in boys during the early stages of puberty until the middle of puberty. This usually lasts from 6 months to 2 years.

In adult males, however, gynecomastia is typically caused by a different condition. Liver disease, low testosterone, and kidney failure can cause gynecomastia. However, the most common cause of breast enlargement in men is due to medication and drug use. In younger adult males, the leading causes of gynecomastia are marijuana use and steroid abuse.

Additional medications, however, can also cause this disorder including HIV medication, heartburn and ulcer medications, antifungal medications, antibiotics, chemotherapy to treat cancer, antidepressants, hormone treatment for prostate cancer, and some herbals including lavender and tea tree oil.

Diagnosis & Therapy

Gynecomastia is typically diagnosed through a physical examination and collection of medical history. Important parts of this physical exam are the full evaluation of the breast tissue as well as palpation to look for breast cancer and benign excess fatty tissue.

The exam will also include an evaluation of the development and size of the penis and testicles, and an examination for tumors in this area as well. Invasive tests are typically not necessary. However, a biopsy may be done if the lump in the breast is unusually large, tender, one-sided, or hard. This will rule out additional problems.

Any male with a family history of breast cancer who finds a lump in their breast area should have it biopsied and checked. A medication review may also reveal the cause of of a male's gynecomastia.

Lab tests may be done to further investigate if there is a primary cause that is creating enlarged breasts. These tests may look for liver disease through the examination of the presence of aspartate transaminase or alanine transaminase. To determine kidney damage, tests can be run for levels of serum creatinine, and hyperthyroidism can be detected by looking at the levels of thyroid-stimulating hormones.

Treatment & Therapy

Gynecomastia in young males does not require additional treatment other than time. Mild cases in young males may often be treated with certain lifestyle changes and proper habits such as a healthy diet and regular exercise. Certain medications can be prescribed to help alleviate gynecomastia, but medical treatment is most effective if it is started within 24 months of the first notice of breast enlargement.

If the gynecomastia is caused by disease or medicine, treating the disease or discontinuing the medication will help to cure gynecomastia. Hormonal treatment can be done if there is an imbalance in estrogen and testosterone. If all other treatments have failed, surgery is an option.

If surgical removal of the glandular breast tissue is required, this may include a subcutaneous mastectomy, a liposuction-assisted mastectomy, or a laser-assisted liposuction. It can also include a laser-lipolysis without any liposuction. There can be complications along with the mastectomy that may include infection, hematoma, breast asymmetry, areola necrosis, seroma, deformities, and scars.

Prevention & Prophylaxis

There are certainly ways to prevent the onset of gynecomastia. Some factors that are controllable that can reduce a male's risk include not using illegal drugs, avoiding alcohol, and taking a review of any medications that are being used. Be sure to ask a doctor for an alternate medication if a side effect includes gynecomastia.

In prostate cancer patients who receive androgen deprivation therapy, radiation therapy as well as tamoxifen have shown to prevent breast pain and gynecomastia from forming. These treatments are most effective when they are done ahead of time because they are less effective once gynecomastia has onset.

Finally, watch for weight gain and poor nutrition overall. Staying healthy and fit is a great way to keep your body in shape and to not give your hormones a chance to get out of balance. Do not use illicit substances that may change the natural chemistry of your body and therefore lead to this undesirable issue. Eat nutritious foods that work with your body to stay healthy and fit.