What is Gynecomastia? A Comprehensive Guide to Understanding Its Causes, Symptoms, and Treatment Options

A condition that occurs when the male breasts become enlarged as the result of an imbalance of testosterone and estrogen, gynecomastia is typically found in prepubescent males and will often correct itself through puberty.

However, not every case is a temporary one as this can grow into a permanent condition in older men who often elect to have male breast reduction surgery to correct the issue.

Common Symptoms of Gynecomastia

When there is a significant imbalance in testosterone and estrogen, glandular tissue begins to accumulate under the nipple of one or both breasts and this collection of excess breast tissue can lead to soreness and pain in the area.

The breasts will start to overdevelop and appear malformed or misshapen due to the exponential increase in tissue, resulting in an uneven or overweight appearance.

Men who have been diagnosed with gynecomastia may suffer emotional discomfort along with physical discomfort as they grow self-conscious and lose confidence in the way they look. Patients may feel embarrassed by their appearance and this can have a damaging effect on self-esteem.

In some cases, these symptoms can also be a result of pseudogynecomastia in which there are visible indications of accumulated excess fat in the breasts without any signs of the condition itself. This can be found in men who have undergone significant weight loss but are not seeing the expected change in the size and shape of the breasts. The reason is usually due to a delay in the retraction of the skin of the breast after the fatty tissues have been eliminated.

Causes of Gynecomastia

A patient may be suffering with gynecomastia due to a variety of potential causes ranging from the use of certain medications, hereditary factors, or the body's natural timeline of growth in the individual. In order to correct the condition, surgery may be necessary.

Physiologic Factors

If the symptoms of gynecomastia are due to physiologic factors, no treatment options are needed to address the condition. Prepubescent males with signs of excess breast tissue will usually outgrow the condition as they reach puberty. The tissue will decrease on its own and present no further symptoms.

Idiopathic Factors

But not all cases of gynecomastia in young males are due to physiologic causes, it may just be a hereditary trait passed down from one generation to the next. Some patients may have enlarged, fatty breasts because their father or grandfather had this condition and that's all. In cases such as these, there are non-invasive treatment options to address the issue.

Pathologic Factors

Serious health issues could also be attributed to the development of gynecomastia. Chronic liver disease, kidney disease, and thyroid conditions or tumors of the breast, the testicles, or the brain have been presented as common factors related to gynecomastia. There are treatment options available for pathologic gynecomastia but a proper medical diagnosis must be performed before an effective protocol can be implemented to eliminate the condition.

Pharmacologic Factors

Excess fatty tissue in the breast could be a side effect of certain types of medication to treat a variety of conditions from hair loss to high blood pressure. Some of the most common prescriptions that have been shown as a cause for gynecomastia include:

Antibiotics (Isoniazid, Ketoconazole, Metronidazole)
Blood pressure medications (Amlodipine, Verapamil, Enalapril, Nifedipine)
GI medications (Cimetidine, Ranitidine, Omeprazole)
Hair loss (Cyproterone, Finasteride)
Hormones (Anabolic steroids, Estrogen, Growth Hormone)
Psychiatric medications (Valium, Phenothiazine, Amitriptyline)

In most cases, stopping use of the drug that has caused the condition is the most effective method for eliminating it. But always consult with your physician before stopping the use of any prescribed medication as this could lead to serious medical complications.

For male patients who continue to present symptoms of gynecomastia after they have ceased taking the medication, further treatment options such as breast reduction surgery may be the most appropriate solution.

What You Need to Know about
Gynecomastia Surgery

Gynecomastia patients who have tried non-invasive treatment methods with little to no success may need more invasive alternatives to address the condition. The two most common procedures are liposuction and tissue excision, though a combination of both together may be required to best effectively treat and eliminate the condition.

Before any surgical intervention is initiated, the patient's symptoms and overall health condition must be taken into account to ensure that gynecomastia surgery is the right choice for removing excess fatty tissue, reducing the size of the breast, and restoring a more natural chest contour.

Liposuction

Liposuction is performed by placing a long thin tube called a cannula into small incisions around the breast. Using suction, the cannula dislodges and removes the unwanted fat to restore the breast to its normal appearance. There are many different techniques for liposuction, making this an effective solution to addressing and treating the condition.

Tissue Excision

This procedure is implemented as a treatment option of gynecomastia when fatty tissue and excess skin needs to be removed. Excision is also used when the nipple and/or the areola needs to be repositioned after liposuction has been performed and the excess glandular tissue eliminated.

These incisions are typically made under the breast or along the edge of the areola to conceal scarring. In some cases, the incision could also be made under the armpit. The excision procedure is also useful for restoring the natural contour of the breast for cosmetic purposes.

Preparation and Recovery

Before any incisions are made, a local anesthetic is administered to numb the incision sites. Some patients will request general anesthesia so they may be sedated for the duration of the surgery. The average length of gynecomastia repair surgery is between one and two hours, based on the amount of tissue that needs to be removed or excised and the complexities of the procedure.

This type of surgery is done on an outpatient basis, patients can return home on the day of the procedure. The use of a compression garment will be necessary to prevent swelling and expedite the healing process.

Results

Most patients who undergo gynecomastia surgery only need to have it performed once. The results are long-lasting with an extremely high success rate. However, it is entirely possible to experience symptoms of the condition again at some point after the surgery has been completed. But the patient can take precautionary steps to prevent the condition from coming back.

This may require lifestyle changes related to the causes of the condition in the patient. If those causes are ignored and changes are not made either before or after the surgery is complete, there is an increased risk of the condition returning and surgery may be necessary again.

Building Muscle After Surgery

Gynecomastia surgery patients will be able to build muscle once the breasts are fully healed. But patients must refrain from working out and performing any strenuous activities for a period of six weeks to prevent any setbacks in recovery.