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Gynecomastia surgery: treatment and course

by Josephine Andrews
Published: Last Updated on 376 views

Gynecomastia is a benign growth of the mammary glands in men It occurs unilaterally or on both sides. Gynecomastia is to be distinguished from what is known as pseudogynecomastia (lipomastia), which is caused by increased formation of fatty tissue in the breast area when you are very overweight. Gynecomastia is not always pathological, but also occurs naturally in certain phases of life in boys or men. Here you can find out everything you need to know about it.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

N62

quick overview

  • Symptoms: Enlarged male breasts due to growth of the mammary gland tissue, on one or both sides, often no symptoms, sometimes a feeling of tension in the breasts, restricted movement or sensitive nipples
  • Causes: Physiological causes through an imbalance of male and female hormones (such as neonatal, pubertal or old-age gynecomastia), pathological causes such as errors in the genetic material, chronic diseases, cancer, external supply of hormones through medicines, drugs or care products
  • Diagnosis: Documentation of the medical history, palpation of the breast, abdomen and testicles, imaging procedures such as ultrasound , possibly blood tests , if cancer is suspected mammography, tissue removal, sometimes chromosome analysis
  • Therapy: In the case of temporary forms, no treatment or psychological support, if the cause is known, correction of the hormonal balance such as avoiding hidden sources of estrogen, possibly taking medication that affects the hormonal balance, surgery
  • Prognosis: Physiological forms often recede on their own. In the case of pathological forms, underlying diseases and hormonal disorders are treated accordingly
  • Prevention: No preventive measures, if the hormonal balance is out of balance, for example due to overeating, heavy alcohol or drug consumption, it is advisable to avoid these triggers

What is gynecomastia?

Gynecomastia refers to breast growth in men. During this process, the glandular tissue grows, which goes through various stages similar to that in girls during puberty. Doctors distinguish different forms of gynecomastia based on their causes. Depending on whether it is a natural (physiological) or a disease (pathological) process, the doctor decides on a suitable treatment.

How do you recognize gynecomastia?

In gynecomastia, the mammary gland grows. This happens either on one side or on both sides.

There are sufferers who have no symptoms. Others complain of a feeling of tightness in the breasts, are restricted in their movement or are particularly sensitive to touching the nipples.

What are the causes of gynecomastia?

Normal testosterone levels in young adult males are approximately six nanograms per milliliter of blood (ng/ml) and normal estrogen levels are 20 to 40 picograms (pg/ml). This results in a testosterone / estrogen quotient of about 200-300.

The mammary gland tissue reacts very sensitively to fluctuations in the male hormone balance, so that imbalances promote breast growth. All things that interfere with this balance are therefore considered risk factors for the development of gynecomastia.

Physiological gynecomastia

Physiological gynecomastia is caused by an altered balance between female sex hormones (oestrogens) and the male sex hormones (testosterone). The proportion of the female messenger substance, which is always circulating in the body in small amounts in men, increases. However, these changes do not always result from pathological processes, but sometimes occur naturally in certain phases of life:

neonatal gynecomastia

About 60 percent of all male newborns have a small breast base in the first few weeks. This is temporary and disappears again after a few weeks or months. Male babies come into contact with female hormones during pregnancy and in the first few weeks of their lives: estrogen is passed on to the child through the placenta and breast milk. The child’s liver does not break down this hormone as efficiently at the beginning. Therefore, there is a slight breast formation.

pubertal gynecomastia

During puberty, some boys’ breasts grow because the balance of sex hormones changes. Due to the serious changes in the hormone balance, it happens that female sex hormones are also increasingly formed. Since adipose tissue plays a role in the conversion of the male sex hormone testosterone to female estrogen, pubertal gynecomastia is more common in overweight adolescents.

old age gynecomastia

With age, the proportion of body fat increases and the production of testosterone decreases. The enzyme aromatase, which is particularly abundant in adipose tissue, converts testosterone to estrogen. Both effects favor the growth of mammary gland tissue. This form of breast growth is also more common in overweight people.

Pathologic gynecomastia

Breast growth in men may also be an indication of a pathological process in the body that disturbs the hormone balance, or that takes place directly in the breast itself.

Hereditary gynecomastia

Some men have a problem in the production or processing of hormones. For example, enzymes do not form certain precursors of the male hormone, or both testicles – the main producers of testosterone – are missing. The doctor gets the first indications of this form of gynecomastia in the patient consultation, because “men with breasts” are then often already known in the family.

Sometimes sections of the genetic material DNA are missing, or the (female) X chromosome is duplicated ( Klinefelter syndrome ). Then it happens that the breast, pelvis and buttocks are female and at the same time male sexual characteristics are present. Such deviations in the genetic material usually arise during the production of sperm and the egg cell or during their fusion (fertilization).

chronic diseases

The liver breaks down hormones, especially estrogen. A liver disease such as cirrhosis of the liver may lead to an excess of female hormones and subsequently to gynecomastia.

A diseased kidney can also cause gynecomastia. A functional disorder ( renal insufficiency ) changes the filter function and thus affects the hormone balance. With severe malnutrition, such as that which occurs in anorexia , testosterone levels drop drastically and the liver stops working at full capacity. If a normal diet follows such a starvation phase, the hormone level is still disturbed for a certain time, which promotes gynecomastia.

The loss of one or both testicles also sometimes changes the ratio of testosterone and estrogen to such an extent that the mammary gland tissue grows stronger. There are also other diseases that change the hormone balance, such as an overactive thyroid gland (hyperthyroidism).

cancers

Tumors are clusters of cells that have lost their normal function. Some tumors produce effective amounts of hormones themselves, so that an excess of these messenger substances circulates in the body. Sometimes these are sex hormones that may stimulate breast growth. In this case one speaks of “paraneoplastic symptoms” (neoplasia = new tissue formation).

Mammary gland cancer (mammary carcinoma) also occurs in men. This is much rarer than in women and is therefore often recognized late. The acute, unilateral occurrence is typical. In contrast to gynecomastia, in which the breast tissue is rather soft, elastic and evenly distributed around the areola, the breast tissue in breast cancer is usually firm and unevenly distributed.

Medication, drugs or personal care products

A fairly common cause is the external supply of hormones or substances that affect the hormonal balance. Some heart medications, antibiotics or antidepressants also change hormone metabolism. In addition, long-term heavy alcohol or drug consumption (marijuana, heroin) is a possible cause of a hormone imbalance with gynecomastia.

Small amounts of artificial female hormones are found in some skin and hair care products and enter the bloodstream through the skin or scalp . Certain chemical substances contained in lavender or tea tree oil are suspected of having an estrogen-like effect. More studies are needed to confirm a possible association with gynecomastia.

pseudogynecomastia (lipomastia)

It is important to differentiate gynecomastia from pseudogynecomastia (lipomastia). In the case of pseudogynecomastia, the glandular tissue does not increase, but instead accumulates fat in the breast. Pseudogynecomastia occurs primarily in people who are very overweight and obese ( adiposity ). You can use your BMI (Body Mass Index) to estimate your overweight.

Which examinations and diagnoses are carried out for gynecomastia?

In the case of enlarged male breasts, those affected turn to the following doctors, depending on their age and cause: general practitioners, pediatricians, specialists in urology, andrology (men’s health) or endocrinology (hormones).

The doctor’s most important tool for gynecomastia is the patient interview ( anamnesis ). The doctor gets indications of a hereditary form if there are already “men with breasts” in the family. He asks whether and which medicines or drugs are taken regularly. If it is a natural growth process during puberty, no further diagnostics are usually necessary for boys under the age of 15.

The doctor diagnoses gynecomastia when the diameter of the areola is more than three centimeters. Based on the shape and size of the nipple , the growth of the breast can be divided into stages (so-called Tanner stages):

  • Stage B1: No mammary gland palpable
  • Stage B2: areola enlarged, mammary glands bulging
  • Stage B3: Mammary gland body larger than areola
  • Stage B4: Solid mammary gland, areola stands out
  • Stage B5: Corresponds to the mature female breast

Palpation of the breast is helpful to distinguish between real gynecomastia and pseudogynecomastia. In this way, the doctor quickly distinguishes glandular tissue from simple fatty tissue and assesses whether there is abnormal growth of the mammary gland tissue. Some doctors prefer to determine this difference with the ultrasound machine.

In addition, the doctor determines in the blood especially the liver and kidney values ​​as well as the hormone levels of estrogen and testosterone and their breakdown products.

An ultrasound scan of the testicles and abdomen is important to assess where hormones are produced. In addition, the doctor feels the testicles and checks for structural changes or lumps, for example. In adolescents, the development of the penis and physique are assessed at the same time. This allows conclusions to be drawn about physical development and the stage of puberty. Sometimes the doctor also uses imaging methods such as X-rays or CT ( computed tomography ).

In the case of unilateral gynecomastia with hard tissue parts (lumps), a mammography is carried out on the person concerned to rule out breast cancer. If a malignant tumor is suspected, the doctor will order tissue removal.

If no cause can be found for the gynecomastia or if it has existed since birth or puberty, a chromosome analysis may be helpful to rule out genetic disorders. For cost reasons, this examination is only carried out if there are further indications of a genetic disease.

How is gynecomastia treated?

In the case of gynecomastia, the treatment depends on the cause of the disease. If the problem is temporary, such as pubertal gynecomastia, it will go away on its own. Treatment is only necessary when pain occurs or psychological problems develop due to cosmetic reasons. If the level of suffering is very high, it is advisable to consult a clinical psychologist.

If the cause is known and treatable, treatment aims to correct hormone levels. If this is not possible with simple means such as changing your diet or avoiding hidden external sources of estrogen, the doctor prescribes medication that interferes with the hormone balance. This is done either by directly administering testosterone or by blocking the conversion, production and action of the female hormone estrogen.

However, such drug therapy is controversial. In addition, there is the assumption that this therapy will only show an effect in the first few months after the start of breast growth.

Gynecomastia surgery

If medication doesn’t help, the doctor may suggest surgical removal of the breast. Read all about this in the article on gynecomastia surgery .

Course of the disease and prognosis

In the case of physiological gynecomastia, treatment is only necessary if the changes are a burden to the patient. In addition, it is often a temporary appearance, which recedes by itself after some time. Puberty gynecomastia, for example, usually resolves again by the age of 20. If gynecomastia was triggered by a phase of starvation followed by a phase of normal nutrition, it usually disappeared again within one to two years.

If it is a pathological gynecomastia, various examinations help to identify possible underlying diseases and hormone disorders and to treat them accordingly.

If there is pseudogynecomastia, this is sometimes cosmetically distressing for the patient, but has no clinical significance. Often there are also mixed forms, because fatty tissue plays an important role in the hormone balance in men and therefore also in gynecomastia.

Can you prevent gynecomastia?

Gynecomastia has a variety of triggers that have a natural or pathological origin. There are no reliable measures to specifically prevent gynecomastia.

If the hormone balance is out of balance, for example due to overeating, alcohol or drug abuse, and those affected notice breast growth, it is advisable to reduce weight or stop heavy alcohol or drug consumption.

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