While we refer to the condition colloquially as 'man boobs,' the medical term for the swelling of male breast tissue is gynecomastia. Gynecomastia affects at least 25% of men aged 50 to 69, and gynecomastia surgery (male breast reduction) is one of the most popular cosmetic procedures.

What Exactly Is Gynecomastia?

Gynecomastia is an endocrinology disorder in which the male breast tissue swells. A hormone imbalance with a higher percentage of estrogen than usual is the cause of gynecomastia. During puberty, boys' bodies produce primarily testosterone and only a trace of estrogen, the dominant hormone in girls' sexual development. When testosterone levels are low, the ratio of the two sex hormones becomes unbalanced. Higher estrogen levels can cause male breast tissue to swell. While gynecomastia is not harmful to one's health, it can be a cosmetic issue with emotional consequences.

Gynecomastia Causes

Gynecomastia can affect men at various stages of life and is frequently caused by hormones. Because of the residual effects of their mother's estrogen, newborn males frequently have enlarged breasts at birth. During puberty or in older men, a hormonal imbalance can occur, resulting in a higher estrogen to testosterone ratio.

Boys who are born with enlarged breast tissue as a result of estrogen in their mother's placenta usually see the swelling go away after a few weeks. Meanwhile, pubertal gynecomastia affects young men during puberty beginning as early as age 10 and can last for several years; up to age 18. Gynecomastia cases reappear later in life. As men age, their testosterone levels decrease and their fatty tissue increases, which can result in senile gynecomastia.

It's not just hormones, though. Obesity, malnutrition, liver disease, hyperthyroidism, hypogonadism, prostate cancer, and kidney failure can all be causes of gynecomastia. It can also be caused by drugs like marijuana or heroin, prescription medications like anabolic steroids, corticosteroids, digoxin, and calcium channel blockers, Flagyl, Propecia, Spironolactone, Valium, and Zantac, to name a few, and herbals like lavender or tea tree oil. There isn't always a clear difference in appearance based on etiology.

How to Recognize Gynecomastia

Breast pain can be startling when gynecomastia first appears. A lump of fatty tissue could be the first sign. The lump may feel tender to the touch as the swelling progresses, but the sensitivity usually subsides. While one breast may be larger than the other at first, they tend to even out.

The term 'gynecomastia' refers to any enlargement of the male breast, but there are grading systems in place to classify the condition's severity. The classification models of Simon and Rohrich are summarized below:

Grade I: Minor enlargement without excess skin (< 250g of breast tissue)

Grade IIa: Moderate enlargement without excess skin (250 to 500g of breast tissue)

Grade IIb: Moderate enlargement with minor excess skin (250 to 500g of breast tissue)

Grade III: Severe enlargement (> 500g of breast tissue) with grade I ptosis (read: sagging)

Grade IV: Severe enlargement with grade II or grade III ptosis 

Gynecomastia Surgical Treatments

While gynecomastia does not always cause medical problems, male breast reduction procedures are becoming more popular in order to address the condition's aesthetic and psychological effects. Liposuction, excision, or a combination of the two are the two most common and effective procedures.

Patients with mild to moderate gynecomastia, characterized by breast enlargement with minimal gland hypertrophy and no excess skin, are ideal candidates for liposuction alone. Many patients also have fibrous glandular tissue under the nipple, which can be treated with direct excision by making a small incision around the areola. When performing liposuction for gynecomastia, techniques such as power-assisted liposuction (PAL) or ultrasound-assisted liposuction (UAL) can more effectively remove the fibrous tissue.

More invasive techniques may be required in more severe cases. To address ptosis and excess skin, severe gynecomastia necessitates not only liposuction but also skin excision. After the sagging skin and tissue have been removed, the nipple-areola may need to be temporarily removed and replaced as a graft to a more appropriate position on the chest in many severe cases.

Patients typically wear bandages and support garments during the recovery period to reduce swelling and support the chest as it heals. Depending on the procedure, a tube may be temporarily inserted beneath the skin to drain excess fluid. Patients will be swollen for several weeks, but most people will be able to resume normal activities within a few days.

The average cost of gynecomastia surgery in Mumbai in 2020 was around Rs 90000, and it should be noted that the procedure is not covered by most insurance plans.

Non-Surgical Gynecomastia Treatments

While non-invasive treatments for gynecomastia are not as effective as surgical treatments, a recent study discovered three classes of medical treatment for gynecomastia: androgens (i.e. testosterone, dihydrotestosterone, and danazol), anti-estrogens (clomiphene citrate and tamoxifen), and aromatase inhibitors (letrozole and anastrozole). Many patients do not improve significantly after treatment.

If patients have an abnormally low level of testosterone, it can be given, and danazol, a synthetic form of testosterone that reduces estrogen production, may be somewhat helpful. There is no real medical treatment for gynecomastia in general.

Before resorting to prescription medication, it is possible that eliminating any lifestyle factors that may be contributing to gynecomastia would be a better bet. If gynecomastia is caused by something other than hormones, the first step is to treat the underlying cause. This includes discontinuing any offending agents, such as medications or illegal drugs, removing a tumor, and treating any underlying systemic disease.

The Bottom Line

Gynecomastia affects a large proportion of the male population over the course of a lifetime, and while the medical implications are minor, men with enlarged breast tissue may seek treatment to reduce the size of their chest.

Whether patients choose liposuction, excision, or a combination of the two, the outcomes of gynecomastia surgery are usually permanent. It should be noted, however, that gynecomastia caused by non-hormonal factors such as prescription medications, illicit drugs, or weight gain will necessitate patients maintaining a healthy lifestyle. Consultation with a board-certified plastic surgeon will ensure that men receive the best treatment possible for their condition.

Call 9930998023 to book your consultation with Dr Siddharth Prakash.

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