What is Gynecomastia?

Gynecomastia is a enlargement of the male breast tissue . The male breast looks heavy  and enlarged giving a appearance of female breast . it is usually seen in young boys and adult males and is usually caused by imbalance in hormones estrogens and testosterone.

What are the causes of Gynecomastia?

gynecomastia surgery

There are multiple causes of gynecomastia but the main cause is imbalance in hormones estrogen and testosterone in puberty . The other causes which may cause gynecomastia are discussed .

Gynecomastia in Infants – Infants develops gynecomastia due to effects of mother estrogen . Generally the  swollen breast tissue regress once the estrogen level falls .

Gynecomastia due to puberty – In puberty it devlop again due to hormonal imbalances . The swollen breast tissue regress without any treatment .

Gynecomastia in adults  –  In Adults , the testosterone level falls due to ageing  and hence  the estrogen level rises , which again leads to increased breast tissue .

Medications that may cause gynecomastia

  1. Anabolic steroids prescribed by doctors or used by body builders . Steroids are converted by the body (often fat cells) into estrogen. This increase in estrogen levels is what can cause men to develop unwanted breast tissue.
  2. Anti Androgens like flutamide , finasteride and spironolactone  can cause gynecomastia when used prolonged .
  3. Patients with anti retroviral therapy .
  4. Anti – anxiety medications .
  5. Tricyclic antibiotics
  6. Antibiotics
  7. Ulcer medications .
  8. Prolong use of Digoxin and calcium channel blockers .   

Alcohol and substance abuse

  1. Alcohol
  2. Marijuana
  3. Heroin

Health Conditions

Hypogonadism – condition which leads to decrease testosterone production like klinefelters and pituitary insufficiency

Ageing – ageing leads to decrease testosterone production .

Tumors – testicular  tumors , pituitary tumors and adrenal tumors

Kidney failure – Patient on Dialysis devlop gynecomastia due to hormonal changes

Liver failure –  cirrhosis and liver failure may causes Gynecomastia .

Majority of gynecomastia cases are idiopathic. that is no cause explained.

Do Gynecomastia regress on this own ?

Yes , usually  pubertal gynecomastia regress on its own . it may take six months to two years to regress but once the glandular tissue develops its difficult to remove the glandular component of breast tissue .

What are the symptoms of Gynecomastia ?

The primary symptom of gynecomastia is enlargement of the male breasts. As mentioned before, gynecomastia is the enlargement of glandular tissue rather than fatty tissue.  Usually gynecomastia present both as glandular and fatty component enlargement . It is typically symmetrical in location with regard to the nipple and may have a rubbery or firm feel. Gynecomastia usually occurs on both sides but can be unilateral in some cases. The enlargement may be greater on one side even if both sides are involved. Tenderness and sensitivity may be present, although there is typically no severe pain.

What are the various grades of gynecomastia ?

Grade 1

Puffy nipple is caused by swelling of this excess breast tissue. This swollen tissue causes the areola to bulge, enlarge and become shiny. The nipple projects outward causing the characteristic “puffy nipple” appearance.  It may be painful which means that the gynecomastia tissue is actively inflamed. Puffy nipple occurs primarily when the patient is hot or emotional. Patients often describe how it goes away when they get cold, pinch their nipple, or when they come out of a pool. It is caused by the swelling of excess breast tissue located directly below the nipple. This swollen breast tissue makes wearing a tight T-shirt almost impossible and going shirtless embarrassing. For body builders, it disrupts the masculine, defined look they work so hard to achieve. 

Grade 2

Grade 2 gynecomastia is defined as a mild or moderate enlargement of the breast that expands to the width of the chest. At this grade, some males wear loose clothing for their chest to not be as noticeable. Sometimes, a doctor might suggest surgery at this stage, but there are also other non-surgical treatment options you can try, such as abstaining from certain drugs, weight loss, and compression shirts.

Grade 3

When gynecomastia reaches grade 3, the breast enlargement becomes more moderate to significant. The chest’s width is expanded, and there’s an increase in excess skin. At this stage, the condition can become highly visible, even with wearing loose clothing. As the condition is more visible, it may increase the sense of insecurity men feel about their bodies.

Grade 4

Grade 4 is the most severe stage of gynecomastia a male can have. This stage is defined as having a significant breast enlargement with a large amount of excess skin. The chest in this condition has more of a feminine breast appearance.

What is the definitive treatment of gynecomastia ?

Gynecomastia is a anatomical condition and to correct the anatomy surgery is the only choice of treatment . Medical treatment has no promising role in gynecomastia .

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