Gynecomastia

Gynecomastia, denotes the atypical enlargement of the male breast tissue. It is a rather common disorder that induces glandular and fatty tissue growth, culminating in the formation of female-like breast buds. Gynecomastia, although frequently temporary and harmless, may occasionally indicate a pre existing medical condition or be an unintended consequence of specific medications. 

What is Gynecomastia?

Gynecomastia is an abnormal male breast growth. While males do not develop fully developed breasts, a minute quantity of glandular breast tissue is present beneath the nipple and areola region at birth in all boys. The bodies of males predominantly produce the hormone testosterone during puberty; it regulates their sexual development. 

However, males also generate a certain quantity of estrogen, the hormone that governs the process of sexual maturation in females. Testosterone and estrogen must maintain a healthy balance. Estrogen may increase as a man's testosterone levels drop throughout adolescence or aging, causing breast growth. 

Pseudogynecomastia, or the accumulation of excess fat around the breast region, can appear in specific cases. Gynecomastia has the potential to impact both adult men and adolescent boys. Prevalence rates for men over 50 are approximately 50%, while men over 50 may experience gynecomastia symptoms to some degree.

Causes

Gynecomastia symptoms can result from several reasons that affect testosterone and estrogen levels, like:

Hormone Imbalance 

A hormonal imbalance between estrogen and testosterone frequently brings on gynecomastia in males. Estrogen promotes the development, growth, and maintenance of breast tissue, whereas testosterone inhibits its growth via a negative feedback mechanism in most cases. Occasionally, the precise fat of the hormonal imbalance remains obscure; it can show up naturally. In many people, hypogonadism or Klinefelter syndrome can alter hormone production and balance. Herbs, vitamins, anti-androgens, and some chemotherapy drugs can disturb hormone levels and promote breast development. 

Obesity 

Being overweight or obese increases the risk of gynecomastia. Due to androgen aromatization to estrogens in fat tissue, overweight men have higher estrogen levels. The increased circulation of estrogen can subsequently stimulate the proliferation and enlargement of glandular breast tissue. Obesity also causes extra-abdominal and chest fatty deposits, which manifest clinically as pseudogynecomastia. Some individuals may experience reduced breast size due to weight loss, which decreases estrogen levels. In cases of genuine gynecomastia, residual breast tissue may persist despite significant weight loss, and gynecomastia surgery is one of the options to remove it.

Puberty

Hormone fluctuations are common in males during adolescence, when their bodies endure significant developmental changes. Estrogen secretion increases during puberty to facilitate physical maturation. A temporary decline in testosterone levels during this period permits estrogen to exert control and stimulate breast growth; this is referred to as pubertal gynecomastia. Typically modest and self-limiting, breast tissue enlargement that occurs during puberty resolves itself by the time hormone levels stabilize during the later years of adolescence, coinciding with the completion of sexual development.

Newborn Babies

Transient breast enlargement in newborn baby boys is attributed to the transfer of estrogen from the mother through the placenta's shared blood circulation before birth. The baby undergoes transient breast bud development in response to estrogen exposure, which biologically prepares it to develop as a female while in utero. However, once the placental estrogen support stops, the baby's hormone levels take over, and the condition resolves within a few weeks.

Symptoms and Diagnosis

Gynecomastia symptoms include:

• Swelling or enlargement of breast tissue
• Tenderness or pain in the breasts (especially in teenagers)
• Sensitive or tender nipples that may feel painful when rubbed against clothing
• Bilateral swelling affecting both breasts evenly

Here is how doctors can diagnose gynecomastia:

• Thorough medical history and physical examination by healthcare provider
• Inquiry about medications, medical conditions, and family history
• Breast examination

Treatment

Treatment alternatives differ by the severity and origin of Gynecomastia. Treatment may not be essential in mild situations since the illness sometimes resolves spontaneously without medical intervention.

The pubertal gynecomastia usually goes away naturally within one to three years as hormone levels mature and stabilize, and losing weight can help obese people. Sometimes, if hormonal imbalance is the cause, then treatment options consist of androgen therapies and aromatase inhibitors.

However, gynecomastia that lasts longer than a year may require gynecomastia surgery. Liposuction removes fat, whereas subcutaneous mastectomy removes breast glandular tissue. The surgery reduces breast size in men, enhancing and flattening chest contours. In severe cases of gynecomastia, the weight of excess breast tissue may cause sagging and stretching of the nipple area. The surgery involves surgical improvement of the position and size of the nipple, and excess skin is reduced. 

Complications

While gynecomastia itself is typically not a severe medical condition, it can sometimes be associated with certain complications affecting physical and mental well-being if left untreated. Here are the main complications:

Psychosocial Impact

The adverse effects of gynecomastia on body image and self-esteem frequently result in feelings of humiliation, anxiety, and sadness. There may be self-consciousness among young men regarding their developing bodies. Breast enlargement in adults may result in social isolation and diminished self-esteem. 

Increased Cancer Risk

Although rare, certain studies suggest that males who have Gynecomastia have a marginally increased likelihood of developing breast cancer in old age in comparison to the general population. It is assumed to be caused due to protracted periods of estrogen dominance encouraging abnormal cell development in breast tissue. Nonetheless, the absolute risk continues to be minimal.

Surgical Complications

To restore the natural appearance of the chest, corrective surgery entails procedural risks such as infection, necrosis of the epidermis or nipple, asymmetry, and hemorrhage. Although complications are rare in the hands of skilled practitioners, possible adverse effects include permanent paralysis or hypersensitivity in the pectoral area and visible scarring.

Persistent Gynecomastia

Although uncommon, breast swelling may recur or persist despite medical intervention if the cause is an underlying pathological condition. It may have detrimental effects on quality of life, necessitating ongoing management.

Prevention

Here are some preventive tips:

• Avoid anabolic steroids, androgens, amphetamines, marijuana, opium, and other recreational drugs which can cause hormonal disturbances.
• Moderate or abstain from drinking if at risk.
• Maintaining a healthy weight through exercise and diet can prevent obesity-related estrogen dominance.
• If your drugs cause gynecomastia, discuss safer alternatives with your doctor.
• Consider eating phytoestrogens and minimizing soy, which acts like estrogen.
• Medical disorders that affect reproductive hormone balance must be treated immediately.
• When early symptoms appear, seek medical attention to identify and treat reversible causes before the condition worsens.
• Perform testicular self-exams to look for lumps that could indicate testicular cancer or other problems.

Wrapping Up

Gynecomastia affects many boys and men throughout their lives. It is usually harmless and transient, but persistent cases may damage self-esteem and mental health. A timely medical examination is essential for diagnosing diseases and causes.

Apollo Spectra, a prominent healthcare provider in India, is a pioneer in managing gynecomastia symptoms. Apollo Spectra assures exceptional clinical results for its patients through the utilization of advanced facilities and a highly experienced team of endocrinologists, plastic surgeons, and dermatologists. 

For more information about surgical correction options, evaluation, and management strategies for gynecomastia, contact the Apollo Spectra today.