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Gynecomastia

Gynecomastia is the enlargement of the glandular tissue of the male breast, which is usually non-cancerous (benign). Some men do develop enlarged breast tissue at some point in their lives, but Gynecomastia is more common among teenage boys and older men, but it can occur at any age. However, gynecomastia is different from pseudo-gynecomastia, which is the presence of fat deposits in the breast area of overweight men.

2 out of every 3 teenage boys develop a certain degree of gynecomastia, which can make them feel anxious, embarrassed, and wonder if there is something wrong with them. However, in 9 out of 10 cases, the condition gets better on its own.

Symptoms of Gynecomastia

Symptoms of gynecomastia can vary from person to person, but the most common ones include:

  • Enlargement of the breast tissue on one or both breasts
  • Female-like breast
  • Small and firm enlargement of the tissues behind the nipples
  • Sometimes the area can be painful or tender to the touch

Main Causes of Gynecomastia

The condition, as mentioned, is not cancerous rather it is the benign enlargement of the male breast which can be bilateral or unilateral. The condition is mainly caused by:

Puberty

Although puberty starts once boys reach teenagerhood, sometimes they can start seeing changes as early as 10 years. When this happens, there is a rise in hormones oestrogen and testosterone. The oestrogen hormones encourage the growth of breasts while the testosterone stops the growth. Gynecomastia on the other hand results from hormonal imbalance whereby the female hormones (oestrogen) might be more in the body as compared to the male hormones (androgens).

If the oestrogen levels continue to increase over time, this leads to the growth of breasts making them more visible. By age 15 years, the testosterone becomes higher than the oestrogen, which stops it from having any further effects on the breasts. By age 19 the boy’s breast start to become smaller and eventually flatten. However, this can take some time, and for a smaller percentage of boys, the shrinkage doesn’t happen.

Aging

Age is another cause of gynecomastia. This is because when people get older, they tend to store more body fat, which leads to the production of oestrogen. When it comes to men, as they get older, they start generating less testosterone. This combination of more oestrogen and less testosterone leads to enlarged breast tissue. Weight gain in older men can also lead to enlarged breast tissue.

Other Causes of Gynecomastia

Other causes of gynecomastia can be as a result from side effects of medications or abuse of drugs such as antibiotics, opioids, anabolic steroids and corticosteroids, oestrogen, anti-anxiety medication and heartburn drugs. Poor health, diet, and some herbal products can also lead to gynecomastia.

  1. Medications and drugs: There are certain medications, both legal and illegal, which can lead to the development of breast tissue in men. This is because they may contain a certain amount of oestrogen or have oestrogen-like effects, which can increase it in the body, hence the development of breast tissue in men. Also, some other drugs tend to block the production of testosterone in the body, which increases the oestrogen levels leading to the same effect. Additionally, there are medications that lead to hormone imbalance in the body. These can include medications for hypertension, psychiatric conditions, heart conditions, cancer therapies and stomach ulcers.
  2. Poor Health: Certain medical conditions can lead to the enlargement of the breast tissue in men. This can be just one of the symptoms of a certain health condition, but it is usually not the only one. To know more, it is important to see your physician in order to assess all the symptoms and recommend a way forward.
  3. Herbal products: Herbal supplements and certain herbal skincare products contain oestrogen or have oestrogen-like effects which can lead to enlarged breast tissue in men as a result of hormonal imbalances.
  4. Alcohol: Over-indulgent in alcohol can affect the liver in many ways, which leads to hormonal imbalance. The liver can stop breaking down the circulating oestrogen leading to an increase, which reduces the presence of testosterone. And as result, the growth of breast tissue.
  5. Overweight: An increase in body fat means an increase in oestrogen levels. As a result, one develops enlarged breast tissue.

Gynecomastia Diagnosis

Although your regular physician may be able to diagnose gynecomastia, there are some instances where you might be referred to a breast specialist at a breast clinic.

While there, you will undergo a number of breast exams for a definite gynecomastia diagnosis. These include:

  1. An ultrasound scan
  2. Mammogram
  3. A core biopsy whereby a sample of the breast tissue is taken to be examined under a microscope.
  4. Fine Needle Aspiration (FNA): Here, a fine needle and syringe are used to take samples of the cells to be observed under a microscope.

On the other hand, since the enlarged breast tissue might be as a result of other health conditions, other areas of your body might be examined. Patients found to have physiologic, asymptomatic and pubertal gynecomastia usually do not require further evaluation. However, further evaluation is required if there is a lump that is tender, progressive, of recent onset and of unknown duration, if the breast size is greater than 5cm which is known as macromastia and if there are signs of malignancy, which is positive lymph node findings or hard/fixed lymph nodes.

Treatment of Gynecomastia

In most cases, treatment for gynecomastia is not required. But if the breasts continue to grow over a certain period of time, and other symptoms develop, then further evaluation and treatment is needed. For most people, getting rid of the root cause of the enlarged breast tissue is all that’s required. This include people who’ve developed gynecomastia due to excessive alcohol intake, certain medications, steroids and being overweight. In other occasions, you might need treatment with drugs or surgery to remove the excess tissues.

Drug Treatments

If your specialist recommends gynecomastia treatment with drugs, this means that the enlarged breast tissues can be reduced and eventually flattened out with medication. These drugs include:

  • Danazol: This is a drug that is mainly used to treat tender and painful enlarged breast tissue in men. It reduces the production of oestrogen in the body, and as a result reduces the size of the breasts and the accompanying symptoms. It comes in a tablet form, and can have some side effects like increase in weight, voice changes, and acne.
  • Tamoxifen: This is a drug used to treat breast cancer. On the other hand, research has shown that it can lower the amount of oestrogen circulating in the body, and as result reduce the size of the breasts in men, as well as any painful symptoms that come with enlarged breast tissues. Some of its side effects include loss of libido, and possible nausea.
  • Aromatase inhibitors: These are a range of drugs also used to treat breast cancer. Also, research has shown that they can be used to treat gynecomastia and its accompanying symptoms like pain and tenderness. The side effects of Aromatase inhibitors include reduced bone strength and joint pain.

Surgery

If your gynecomastia does not improve with medication, lifestyle changes as well as removing the root cause of the condition, then surgery might be recommended. This can also apply if the condition is affecting your quality of life.

Surgery for gynecomastia usually depends on the size of the enlarged breast tissue, as well as the amount of excess skin present. This means you may require more than one surgical procedure which may be carried out separately over a period of time or combined into one operation.

One of the most common procedures for treating gynecomastia is liposuction, which is the removal of excess fat. This can be combined with breast reduction surgery (mammoplasty) or done on its own. On the other hand, a breast reduction surgery can also be done without the liposuction. Each case is different and requires a different approach of treatment.

However, since the surgical approach involves the removal of the enlarged breast tissue, there is a slight chance that your gynecomastia may come back.

Does Gynecomastia Increase the Risk of Breast Cancer?

Being diagnosed with any form of breast lump or breast condition can make one feel uneasy, thinking they are at a greater risk of developing breast cancer. Fortunately, gynecomastia does not increase the risk of developing breast cancer nor does it ‘eventually turn into breast cancer’. To stay breast aware, you should continue with the routine breast screening as usual, and if you are concerned about any changes that your breasts might have, it is recommended you visit your doctor at the earliest.

Next Steps

At King’s College Hospital London Dubai, our Breast Care Clinic caters to every type of breast cancer and breast condition. If you are facing any kind of abnormal changes to your breast, regardless how small, get in touch for a consultation with one of our breast doctors. For more information on breast cancer and breast care, book an appointment below.

 

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