Gynaecomastia is a common condition that mainly affects teenage boys and older men, but it can affect men at any age. “Gyno” or “man boobs” as it’s sometimes called, is a benign enlargement of breast tissue in males.
It does not pose any health risks in itself, but it can cause social embarrassment. Fortunately, gynaecomastia is treatable.
TREATMENT FOR GYNAECOMASTIA
- do nothing
- weight loss
Do nothing. Wait for the gynaecomastia to improve spontaneously. 90% of gynaecomastia that develops during puberty improves without treatment. If your gynaecomastia is caused by a prescription medication, speak to your doctor about stopping or changing your prescription. This can lead to spontaneous improvement in three to six months.
Medications with anti-estrogenic effects, such as tamoxifen and clomiphene citrate, have been used to treat gynaecomastia. Medical therapy is most effective in the early stages of gynaecomastia, before fibrosis and thickening of the breast tissue takes place.
Weight reduction combined with exercise will help to improve the contour of the chest area without surgery.
Surgery is necessary when gynaecomastia persists despite non-surgical treatment. Surgical correction involves removal of breast tissue, fat and skin and if needed, reducing the size of the areolae.
Several techniques are available:
Liposuction (a surgical procedure in which fat is removed from the affected area)
Breast reduction surgery (male breast mastectomy)
The type of surgery is tailored to the severity of gynaecomastia. Gynaecomastia severity can range from a mild swelling and puffiness of the nipple to markedly enlarged breast tissue with excess skin, that resembles the female breast.
POTENTIAL DRAW BACKS OF SURGERY
Surgery is an effective treatment for gynaecomastia, but there are potential side-effects:
- bleeding – most common side effect
- bruising and swelling
- loss of nipple sensation
- nipple necrosis
- wound healing problems
- unevenly shaped breasts or nipples
- recurrence of gynaecomastia
- cost – most medical aid insurers will only cover gynaecomastia surgery in exceptional circumstances, such as secondary to medication use
Discuss the benefits and risks of your gynaecomastia surgery with your plastic surgeon so that you have a clear understanding of what to expect.
RECOVERY AFTER SURGERY
Recovery after gynaecomastia surgery takes about 2 weeks. You will be fitted with a pressure garment to wear for one month, to reduce swelling and discomfort. You can gradually get back to exercise after 4 weeks but it is best to avoid intense exercise and weight training for 6 weeks after surgery. Discomfort after surgery is well controlled with pain medication and rest.
CAUSES OF GYNAECOMASTIA
An imbalance between the hormones testosterone and oestrogen cause gynaecomastia. Hormonal imbalances occur frequently around birth, puberty and old age. This is called “physiological” gynaecomastia and is seen at these times of life. Close to two-thirds of boys develop a degree of gynaecomastia during puberty.
Prescription medications, alcoholism and illness can also cause gynaecomastia. But in 25% of men, no cause is found. An increasingly common cause of gynaecomastia is anabolic steroid use.
NOT JUST GYNAECOMASTIA?
In true gynaecomastia, breast tissue can be felt as area of firm tissue below the nipple. Sometimes the areolar (the pigmented part around the nipple) changes shape and becomes large and round.
Gynaecomastia remains the commonest cause for enlarged breasts in men. But sometimes there is another explanation. A commonly mistaken cause for enlarged breasts in men is psuedo-gynaecomastia. This is the accumulation of fatty tissue in the male chest without true breast tissue. This is most often seen as a part of generalised obesity.
Breast cancer is rare in men, but does occur. Signs to watch for include enlargement of only one breast, a discharge from the nipple, a firm lump in the breast or in the armpit, ulceration of the chest area and a strong history of breast cancer in your family.
Endocrine abnormalities such as Androgen insensitivity syndrome, may present with breast enlargement as the first sign.
Testicular cancer usually presents with a lump in the testes, but can present with gynaecomastia. Investigations such as blood tests or ultrasound and mammogram will be ordered if anything other than gynaecomastia is suspected.
Knowledge is power. I hope that this blog-article on gynaecomastia, and the treatment options has been useful. If you are planning surgery you may find helpful information on preparation for your surgery in Plastic surgery companion – a patient guide.