Gynaecomastia - Meaning, Stages, Symptoms, and Treatment

Gynaecomastia is a medical condition characterised by the enlargement of male breast tissue. A rubbery or firm mass develops underneath and around the nipples. The condition can affect males of all ages, including adolescents and older people.

It can affect one or both breasts, sometimes disproportionately and range from a small amount of tissue to significant breast enlargement. The appearance of enlarged breasts is a concern that affects many adolescent and adult males.

Some individuals may possess pseudogynaecomastia based on the anatomy of their abnormally large breasts.

Understanding Pseudogynaecomastia

Pseudogynaecomastia also refers to the enlargement of breast tissue in males. However, in this case, the primary cause of enlarged male breasts is a buildup of fat that often appears around, behind, or below the nipple.

Certain weight-lifting techniques and pectoral exercises can help improve the condition by toning the chest.

It doesn't always look the same in all males with this disease. Some men may have minor gyno whereas others may lie in moderate to severe stages of gyno.

The type or the grades of gynaecomastia depends upon the duration of the disease. The stages are characterised as follows:

1. Grade 1 (Small Breast Enlargement without Excess Skin): A slight amount of breast growth that sticks out from the chest.
2. Grade 2 (Moderate Breast Enlargement without Excess Skin): Breast growth that expands broadly across the chest.
3. Grade 3 (Moderate Breast Enlargement with Excess Skin): Swelling of breast tissue and expansion beyond the chest width.
4. Grade 4 (Significant Breast Enlargement with Excess Skin): Severe breast enlargement with substantial extra skin. The breasts tend to be highly visible and can mimic female breasts.
   
   

The majority of adult men with gynaecomastia do not show any symptoms. However, the following symptoms may be noted:

1. Enlarged Breast: Enlarged and uneven breasts due to uneven growth of glandular breast tissue can be spotted easily and indicate gynaecomastia. 
2. Pain: Enlargement of male glandular breast tissue can build pressure on surrounding nerves and tissues, resulting in pain. 
3. Nipple Sensitivity: Changing hormones are responsible for nipple sensitivity and tenderness. However, it may vary from person to person. 
4. Nipple Discharge: A person may sometimes spot nipple discharge. The colour of the fluid may vary from transparent to pale yellow colour. 
5. Lump of Fatty Tissue Under the Nipple: The development of glandular breast tissue in males, resulting in an enlargement of the breast tissue, can sometimes present as a lump of fatty tissue under the nipple.

Many things can trigger the enlargement of the breast tissues in males. About 50% of males experience mid-pubertal gynaecomastia.

More than 90% of cases resolve naturally within 24 months. Some of the common factors that can cause gynaecomastia are:

1. Hormonal Imbalance: It is caused by an imbalance between oestrogen (hormone majorly present in females) and testosterone (hormone majorly present in males).
   
   Oestrogen, the hormone that governs breast growth, is produced at modest levels in the male body. However, the male breasts tend to grow if there is excess oestrogen production or much less androgen (testosterone).
   
   
2. Excessive Gymming: It is a concern for those who do excessive gymming. These athletes often take anabolic steroids to maximise muscle growth, which can subsequently cause gynaecomastia due to hormonal imbalances (increased oestrogen).
   
   
3. Dietary Supplements: Protein powders contain ingredients that include casein and whey protein, which are derived from cow's milk.
   
   Casein and whey protein powders may be related to gynaecomastia as they are rich in oestrogen. However, it depends on several circumstances, including age and hormonal sensitivity.
   
   
4. Obesity: Being very overweight (obesity) is a common cause of gynaecomastia. This is because being overweight increases oestrogen levels, increasing the breast tissue.
   
   
5. Herbal Products: Plant oils, like tea tree or lavender oils used in shampoo, soaps and lotions, can also be associated with gynaecomastia as they increase oestrogen levels and show testosterone inhibitory action.
   
   However, it is directly linked to the intake of herbal supplements with diethylstilbestrol. 
   
   
6. Genetic: Klinefelter syndrome is a genetic condition where males are born with an extra X chromosome. This leads to abnormal development of testicles and hormonal imbalance, which eventually influences breast size. 
   
   

Gynaecomastia Risk Factors

The condition can develop in any age group. However, the following are the probable risk factors that play a considerable role in increasing the risk for gynaecomastia:

1. Family History: If a person's family members have a history of gynaecomastia, then he may be more likely to develop the condition.
2. Hypothyroidism: Male breast enlargement can be caused by various medical conditions, including low levels of thyroid hormone. 
3. Certain Medications: Medications that affect hormones can also cause gynaecomastia. The list of drugs includes heart medicines (spironolactone, digoxin), antihistamine (cimetidine) etc. 
4. Drugs and Alcohol: Excess consumption of alcohol and drugs such as marijuana or opium can also cause gynaecomastia.
5. Aromatase Excess Syndrome: Mutation in the aromatase gene (responsible for oestrogen synthesis) that leads to excess oestrogen in many families (fathers and sons) increases the risk.
6. Age: With increasing age, testosterone levels decrease, whereas oestrogen levels remain the same, which leads to breast enlargement in older men. 

Although there is no guaranteed way to prevent gynaecomastia, there are steps you can take to reduce the risk of developing the condition.
These steps can help reduce the chances of hormonal imbalance. Some solutions are:

1. Avoid Steroids: Avoiding anabolic steroids can help prevent gynaecomastia because these substances can cause hormonal imbalances, leading to breast enlargement.
2. Avoid Drugs: Avoiding drugs like marijuana, heroin, and methamphetamine can also help in prevention, as these substances can disrupt the hormone balance in the body.
3. Healthy Weight: Maintaining a healthy weight through regular exercise and a balanced diet can help prevent obesity-causing the condition. Obesity increases oestrogen levels.
4. Treating Medical Conditions: Treating underlying health conditions such as liver disease, kidney failure, and hyperthyroidism can help prevent gynaecomastia caused by hormonal imbalances.
   
   

If the patient is concerned about enlarged male breasts, consult your doctor first. The doctor will examine the patient and gather his health and medication history. The doctor may order the following test:

1. Physical Examination: The doctor will examine the breasts for signs of gynaecomastia, such as feeling rubbery or hard.
2. Blood Tests: Blood tests can be done to check hormone levels, majorly an imbalance in hormones such as oestrogen and testosterone levels.
3. Mammogram: A X-ray examination test for breasts is done to rule out the possibility of complications such as breast cancer or cysts.
4. Breast Ultrasound: A breast ultrasound will be recommended to see detailed images of breast enlargement.
5. Biopsy: In some cases, a biopsy may be done to examine a tissue sample from the breast to confirm the diagnosis and rule out any other conditions.
6. Imaging Tests: The healthcare provider may suggest a CT scan or MRI test in some cases. It usually happens when there is a lump that indicates tumour development in the breast region. 
   
   

How to prepare for the doctor's consultation?

Below is some information that a patient can prepare before the appointment with the doctor. The following measures can help the patient get better clarity of the disease: 

1. List down symptoms, including any that may seem unrelated to the condition.
2. The patient must tell the specialist his list of medications and supplements.
3. Ask questions to the specialist. Some of the questions are as follows:
   • What is the cause of my breast enlargement?
   • Are there any risks associated with my breast enlargement?
   • How can I get rid of the breast enlargement at home?
   • Will this condition go on its own?
   • What type of follow-up appointments will I need?
   • At what point do I need to consider treatment for breast enlargement?
   • Will this condition reoccur after the treatment?
   • What is the complication of the treatment?
   • What is the cost of the treatment for this condition?

In most of the cases, it gets 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 the treatment:

Lifestyle Changes for Gynaecomastia

Making some lifestyle changes can help prevent and manage the symptoms of gynaecomastia. They include:

1. Losing Weight: Losing weight through diet and exercise can help reduce fat throughout the body, reducing the size of the breasts.
2. Exercise: Resistance training can help build chest muscles and reduce the appearance of the condition.
3. Discontinuation of an Unacceptable Drug: If a drug is causing gynaecomastia, discontinuing the drug or switching to another drug may be recommended.

Gynaecomastia Treatment without Surgery

There are several non-surgical treatment options available which may be effective for some individuals. However, the most appropriate treatment will depend on the underlying cause and severity of gynaecomastia: 

1. Tamoxifen drug that helps block the action of the female hormone oestrogen 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.

Gynaecomastia Treatment with Surgery

Depending on the severity of the condition, the doctor may suggest one of the following surgical procedures to get rid from this disease:

1. Liposuction: It is a minimally invasive surgical procedure. It uses a cannula to remove excess fat from the breast tissue, reducing the size of the breasts.
   Liposuction is often recommended for patients with excess fat but no glandular tissue.
2. Mastectomy: This is a surgical procedure that removes glandular tissue from the breast.
   Mastectomy becomes necessary if it is severe or has been present for a long time. It may also be recommended for patients with excess glandular tissue but not much fat.
3. Gynaecomastia Surgery: This surgical procedure is a combination of liposuction and excision to remove excess fat and glandular tissue from the breasts for a more comprehensive approach.
   It is best to wait until the age of 17 before considering surgery, as the growth can come back. 

It is advised to wear compression garments which can help hide the appearance of gynaecomastia and provide physical support to male breasts after surgery.

Read also: Gynaecomastia

Gynaecomastia Surgery Cost

Gynaecomastia surgery cost in India can vary depending on several factors, including the type of surgery, the hospital or clinic where the procedure is performed, and the location. Here is a table showing the cost of different types of gynaecomastia surgery:

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

1. Socially Uncomfortable: A person may feel embarrassed, anxious, or depressed.
2. Fibrosis: If left untreated, it can lead to fibrosis, where the breast tissue becomes firmer and more fibrous. This can cause more significant discomfort and make it more challenging to treat the condition.
3. 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 the following:

• Swelling
• Pain or tenderness
• Nipple discharge in one or both breasts

Lifestyle factors and diet of an individual significantly affect the development of a disease condition. Adapting to good dietary habits that can help an individual treat gynaecomastia is important.

Below-mentioned dietary items will help increase testosterone levels and help in fast recovery:

1. 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.
2. Healthy Fats-Rich Foods: Foods such as egg yolks, coconut, coconut oil, olive, almonds, butter, raisins, ginger, and garlic, are rich in healthy fats (polyunsaturated fats and saturated fats), which can reduce stubborn fat from the body.
3. Vitamin-D-Rich foods: Mushrooms, cereals, eggs, trout, and dairy products are rich in vitamin D. Vitamin D increases sperm count and testosterone production.
4. 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.
5. Anti-inflammatory Foods: Food items such as salmon and tuna (fish) are rich anti-inflammatory foods, which help relieve the swelling and tenderness caused due to gynaecomastia.

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

1. Alcohol Consumption: Alcoholic beverages restrict the liver from metabolising excess oestrogen hormones.
2. Processed and Canned Food Items: Chemicals in preserved canned food items can reduce 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 Foods: Excess sugar consumption leads to increased insulin production, which can lower the production of the testosterone hormone.

Gynaecomastia is a condition in which men develop enlarged breast tissue. Hormonal imbalance, medications or medical conditions cause it. It is not usually a serious medical problem and often resolves on its own.

However, in some cases, it can cause pain, discomfort or embarrassment and may require medical intervention such as surgery. If you are concerned about gynaecomastia, you can consult HexaHealth. You will be guided by the experts regarding the treatment plans.

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