Gynaecomastia - Meaning, Stages, Symptoms, and Treatment

Gynaecomastia is a medical condition in which there is a generalized enlargement of male breast tissue, with the presence of a rubbery or firm mass underneath and around the nipples. Gynaecomastia can affect one or both breasts, sometimes unevenly. This condition may affect males of all ages, including newborns, during puberty, and older adults. 

Gynaecomastia doesn't always look the same in all males with this condition. Some men may have minor gyno whereas others may have moderate to severe gyno. The grade or the type of gynaecomastia depends upon the length of the condition. The types of gynaecomastia are as follows: 

1. Small Breast Enlargement without Excess Skin: Characterised by a slight amount of breast growth that sticks out from the chest. 
2. Moderate Breast Enlargement without Excess Skin: Characterized by breast growth that expands broadly across the chest. 
3. Moderate Breast Enlargement with Excess Skin: Characterized by swelling of breast tissue and expanding beyond the chest width.
4. Significant Breast Enlargement with Excess Skin: Characterized by severe breast enlargement with substantial extra skin. The breasts tend to be highly visible and can mimic female breasts.

Majority of adult men with gynaecomastia do not show any symptoms. However, the following signs and symptoms of gynaecomastia may be noted:

1. Lump of fatty tissue under the nipple
2. Pain, particularly in adolescents
3. Breast tenderness
4. Nipple sensitivity with rubbing against clothes
5. Nipple discharge

Many things can trigger the enlargement of the breast tissues in males. Some of the common factors that can cause gynaecomastia are:

1. Hormonal imbalance: This is the most common cause of gynaecomastia. It is caused by an imbalance between oestrogen (female hormone) and androgens (male hormones). Oestrogen, the hormone that governs breast growth, is produced at modest levels in the male body. However, if there is excess oestrogen production or much less androgen, the male breasts tend to grow.
2. Medications: Medicines that affect hormones can also cause gynecomastia. These include heart medicine, amphetamines, anabolic steroids, and chemotherapy drugs. Medicines that treat stomach ulcers, depression, high blood pressure, and prostate cancer can also enlarge breast tissues.
3. Recreational drugs, illicit drugs and alcohol: Alcohol abuse, amphetamines, anabolic steroids used to build muscle, marijuana or opioids can also lead to gynaecomastia.
4. Medical conditions: Male breast growth can be caused by various medical conditions, including hypogonadism (a condition that lowers testosterone levels), liver disease, thyroid disease, Klinefelter syndrome (a rare genetic condition), kidney disorders, adrenal tumours, lung cancer, and obesity.
5. Herbal Products: Plant oils, like tea tree or lavender oils that are used in shampoo, soaps and lotions can also be associated with gynaecomastia. 

Gynaecomastia condition can develop in any age group. However, the following are the probable risk factors for gynaecomastia:

1. Children having symptoms of gynaecomastia that last after their first birthday are more likely to develop pubertal gynaecomastia later in life.
2. Patients with alcoholic liver disease are more prone to develop gynaecomastia.
3. High oestrogen levels increase the risk for gynaecomastia in men.
4. Mutation in the aromatase gene (responsible for oestrogen synthesis) that leads to excess oestrogen in many families (fathers and sons) increases the risk of gynaecomastia.

Gynaecomastia caused by hormonal imbalance cannot be prevented. Still, there are measures to reduce the risk of developing the condition. Some of the measures to prevent gynaecomastia are:

1. Avoid using illicit or recreational drugs, such as anabolic steroids, androgens, amphetamines, marijuana, or heroin.
2. Avoid alcohol consumption.
3. Switch the medications (linked to increased breast growth) under a doctor's supervision.
4. Seek treatment for a substance abuse disorder.

If you're concerned about swollen male breasts, the first thing you should do is consult your doctor. Your doctor will examine you and gather a history of your health and medications. The doctor may order the following test:

1. Blood test to check your hormone levels.
2. Ultrasound of breast: To see detailed photos of your breast growth.
3. Mammogram: A mammogram looks for abnormal growth or alterations in the breast tissue.
4. Biopsy: In this case, a small sample of the breast tissue will be removed and checked for the presence of cancer cells.
5. Computerized tomography (CT) scans
6. Magnetic resonance imaging (MRI) scans

How to prepare for the doctor's consultation?

Below mentioned are some of the information that a patient can prepare before the appointment with the doctor.

1. List down symptoms including any that may seem unrelated to the condition.
2. The patient must tell the specialist the list of medications and supplements that he takes.
3. Ask questions to the specialist. Some of the questions are as follows:
   1. Do have enlarged breasts?
   2. What else could be causing my breasts to enlarge?
   3. What type of follow-up appointments will I need?
   4. At what point do we need to consider other treatments?

Most gynecomastia cases get better slowly and resolve over time without any treatment. However, if there is an underlying condition, the doctor may suggest one of the following methods for gynecomastia treatment: 

Gynaecomastia treatment without surgery

1. Tamoxifen: a drug that helps block the action of the female hormone estrogen in the body. It also helps reduce the pain and breast enlargement symptoms in males with the condition.
2. Hormone replacement therapy (HRT) can be used to manage gynaecomastia. This helps to balance the hormone levels.
3. If the enlarged breast tissues are caused by certain medications, then stopping or switching to a different drug may improve the condition. Consult your doctor before stopping any medication that is used to treat other health conditions.
4. If a particular medical condition is a reason behind your gynaecomastia, then treating that condition will improve your breast size.

Gynaecomastia treatment with surgery

Depending on the severity of the condition, your doctor may suggest one of the following surgical procedures get rid of gynaecomastia:

1. Liposuction: This surgery involves the removal of breast fat but not the breast gland tissue itself.
2. Mastectomy: This surgery involves the removal of the breast gland tissue. This method involves minimal incision and less recovery time.

If gynaecomastia is not treated in time, then it can worsen the symptoms which can be troublesome. The risks and complications of gynaecomastia include:

1. Impact the mental health: You may feel embarrassed or feel anxious or depressed.
2. Development of breast cancer: Men with this condition have a slightly higher risk of developing breast cancer in the future.

When to see a doctor?

The patient can consult the doctor if he experiences:

1. Swelling
2. Pain or tenderness
3. Nipple discharge in one or both breasts

Lifestyle factors and diet of an individual have a significant effect on the development of a disease condition. If an individual is suffering from gynaecomastia, he should know what dietary habits would help him treat the condition. Below-mentioned dietary items will help increase testosterone levels.

1. Anti-inflammatory foods: Food items such as salmon and tuna (fish) are rich in anti-inflammatory which help relieve the swelling and tenderness caused due to gynecomastia.

2. Zinc-rich foods: Food items such as raw milk, yoghurt, nuts, cashew, spinach, and pumpkin seeds are rich in zinc which aids in testosterone production in the body.

3. Foods that are rich in healthy fats: Food items such as egg yolks, coconut, coconut oil, olive, almonds, butter, raisins, ginger, garlic, are rich in healthy fats (polyunsaturated fats and saturated fats) which can reduce stubborn fat from the body. 

4. Vitamin-D-rich foods: Food items such as mushrooms, cereals, eggs, trout, and dairy products are rich in vitamin D. Vitamin D increases sperm count and testosterone production.

5. Freshly squeezed juices: Juices squeezed from fresh fruits such as amla, orange, pomegranate, carrot, cucumber, and pineapple have lower calorie intake that helps reduce weight.

Some food items should also be avoided to reduce the risk of gynaecomastia. Following are some of the food items that should be avoided.

1. Beer and Alcohol: Alcoholic beverages restrict the liver from metabolising excess oestrogen hormones.
2. Processed and canned food items: Chemicals in the preserved canned food items can reduce the testosterone development in the body.
3. Soy products: Products made up of soy such as soy milk and soy-rich snacks contain phytoestrogen that can further convert to oestrogen inside the body.
4. Packaged and deep-fried foods: these food items are rich in saturated fat that results in the accumulation of fat tissue around the chest. 
5. Sugary food: Excess sugar consumption leads to increased insulin production which can lower the production of the testosterone hormone.