Gynecomastia

All the information on the causes and the most effective treatments for abnormal development of the mammary glands in men and boys.

Symptoms and Causes

Gynecomastia is the abnormal enlargement of the breasts in men and boys. It is caused by an increase in the amount of mammary gland tissue. When it is due to excess fat accumulation, it is referred to as pseudogynecomastia.

Breast enlargement is not always bilateral. Gynecomastia may occur in only one breast, or the tissue may grow irregularly on both sides.

Although it often has a significant emotional impact, gynecomastia is not a serious health problem and, in some cases, resolves spontaneously. When treatment is required, it focuses on addressing the underlying cause or on surgical removal of the fibrotic tissue. In all cases, the prognosis is good, and patients recover completely without complications.

Symptoms

The characteristic symptoms of gynecomastia include:

Breast tissue enlargement: Increase in glandular breast tissue in one or both breasts.
Inflammation.
Pain.
Hypersensitivity to touch, pressure, or friction.
Occasionally, nipple discharge: fluid secretion from the nipples.

Causes

The most common cause of gynecomastia is a hormonal imbalance in which the body produces a higher amount of estrogens than testosterone, the predominant hormone in males. These changes may be associated with the following conditions:

Physiological hormonal changes: Certain stages of development are associated with abnormal breast development in males.
Infants: Newborns are exposed to elevated estrogen levels transferred during pregnancy; therefore, approximately 50% of male infants are born with breast enlargement, which usually resolves within two to three weeks.
Adolescents: Puberty involves multiple hormonal changes that may lead to breast tissue development. In most cases, no treatment is required, as it resolves within a few months, although it may persist for one or two years.
Hypogonadism: The testes, which are the male sex glands, do not produce sufficient testosterone.
Hyperthyroidism: Excessive production of thyroid hormones.
Renal failure: Dialysis treatment may lead to hormonal alterations.
Liver failure: Affects hormone metabolism and levels.
Malignant tumors: Certain tumors (of the testes, pituitary gland, or thyroid) produce hormones that disrupt hormonal balance.
Certain medications: Some pharmacological treatments may alter hormone levels and cause gynecomastia, including:
Antiandrogens.
Antiretroviral drugs.
Amphetamine-containing drugs.
Anxiolytics.
Opioids.
Chemotherapy.
Antidepressants.
Calcium channel blockers.
Abuse of harmful substances, such as illicit drugs, anabolic steroids used to promote muscle growth, or alcohol.

Risk Factors

Factors that increase the risk of gynecomastia include:

Puberty, due to significant hormonal changes.
Obesity: enzymes in adipose tissue can convert testosterone into estrogen.
Advanced age, as testosterone production decreases.
Use of any of the medications listed above.
Presence of underlying conditions associated with gynecomastia.

Complications

Gynecomastia does not cause physical complications; however, it often has a negative impact on mental health. Most patients experience:

Low self-esteem.
Body image dissatisfaction.
Depression.
Social withdrawal.

Although less widely recognized, breast cancer can also occur in men, and the risk is increased in patients with gynecomastia (estimated to be four times higher). It is essential not to overlook this possibility. Suspicion should arise in the presence of a fixed, hard mass, nipple changes, skin alterations of the breast, or axillary lymphadenopathy.

Prevention

In most cases, gynecomastia cannot be prevented. However, avoiding illicit drug use and limiting alcohol consumption improve overall health and reduce the likelihood of hormonal imbalance.

Which specialist treats gynecomastia?

Gynecomastia is managed within the specialties of plastic, aesthetic and reconstructive surgery, as well as clinical psychology. In most cases, endocrinology and nutrition specialists are also involved in patient care.

Diagnosis

The diagnosis of gynecomastia is based on three fundamental pillars:

Physical examination: Inspection and palpation of the breast to assess the characteristics of breast enlargement, evaluate tenderness, and rule out lesions associated with other conditions.
Imaging studies: Used to evaluate breast tissue and exclude the presence of tumors.
- Ultrasound: Uses sound waves to obtain images of the breast tissue.
- Mammography: Indicated when there is a higher suspicion of breast cancer, as it is more precise. X-ray images are taken from multiple angles to obtain a comprehensive view of the breast.
Comprehensive hormonal evaluation: Blood levels of prolactin (PRL), luteinizing hormone (LH), testosterone (T), human chorionic gonadotropin (hCG), estradiol (E), thyrotropin (TSH), and thyroxine (T4) are measured to identify hormonal abnormalities.

Treatment

Treatment of gynecomastia depends on its severity and underlying cause. The most common approaches include:

Observation: Allowing spontaneous resolution. In adolescents, follow-up evaluations are typically performed every 3 to 6 months to monitor progression.
Discontinuation of causative medications, when applicable.
Pharmacological therapy: Some cases respond to aromatase inhibitors, tamoxifen, or raloxifene.
Surgery: Surgical intervention is the most effective option for patients with pain, changes in breast size, or glandular hypertrophy.
- Chest liposuction: Indicated for patients with pseudogynecomastia. Fat deposits are aspirated using a cannula, sculpting the chest contour and achieving satisfactory aesthetic results.
- Subcutaneous mastectomy: Small incisions are made around the areola to remove glandular tissue.
- Combined procedure: Both techniques are frequently used together to achieve a natural outcome.
Psychological treatment: Therapy focuses on managing feelings of shame, insecurity, and anxiety. Patients are often encouraged to participate in support groups with individuals in similar situations.