While the disorder is often referred to as 'man boobs,' the medical word for male breast tissue swelling is gynecomastia. Gynecomastia affects at least 25% of men aged 50 to 69, and gynecomastia surgery (male breast reduction) is one of the most common cosmetic procedures.
How Is Gynecomastia Defined?
Gynecomastia is an endocrine condition in which male breast tissue swells. Gynecomastia is caused by a hormonal imbalance in which there is a higher than normal level of estrogen. During puberty, boys' bodies generate primarily testosterone and only a trace of estrogen, the major hormone in girls' sexual development. When testosterone levels fall below the normal range, the ratio of the two sex hormones becomes imbalanced. Increased estrogen levels can cause male breast tissue to expand. While gynecomastia has no adverse effect on health, it can be a cosmetic issue with emotional consequences.
Gynecomastia can affect males at any point of their lives and is frequently caused by hormones. Male newborns frequently have larger breasts at birth as a result of their mother's estrogen. At puberty or in elderly males, a hormonal imbalance might recur, resulting in a greater estrogen to testosterone ratio.
Boys born with swollen breast tissue due to the estrogen in their mother's placenta typically see the swelling subside within a few weeks. Meanwhile, pubertal gynecomastia affects young males during puberty, commencing as early as age 10 and lasting several years, up until age 18. Gynecomastia cases rise later in age. Men endure a decline in testosterone levels and an increase in adipose tissue as they age, which can result in senile gynecomastia.
However, it is not solely due to hormones. Gynecomastia can be caused by a variety of medical problems, including obesity, malnutrition, liver illness, hyperthyroidism, hypogonadism, prostate cancer, and kidney failure. Additionally, it can be a side effect of illicit drugs such as marijuana or heroin, prescription medications such as anabolic steroids, corticosteroids, digoxin, and calcium channel blockers, as well as Flagyl, Valium, Propecia, Zantac and Spironolactone to name a few, and even herbals such as tea tree oil and lavender . There is not always a clear distinction in appearance dependent on the etiology.
When gynecomastia first begins to develop, breast pain can be quite severe. A mass of fatty tissue may be the first sign. The lump may feel tender to the touch as the swelling progresses, but the sensitivity normally disappears. While one breast may appear to be larger than the other at first, they eventually even out.
While the term 'gynecomastia' refers to any swelling of the male breast, there are grading systems in place to classify the condition's various degrees. The categorization models of Simon and Rohrich have been condensed as follows:
Grade I: Minor enlargement without excess skin (< 250g of breast tissue)
Grade IIa: Moderate enlargement without excess skin (250 to 500g of breast tissue)
Grade IIb: Moderate enlargement with minor excess skin (250 to 500g of breast tissue)
Grade III: Severe enlargement (> 500g of breast tissue) with grade I ptosis (read: sagging)
Grade IV: Severe enlargement with grade II or grade III ptosis
Gynecomastia Surgical Treatment
While gynecomastia is not always associated with medical complications, male breast reduction operations are increasing in popularity to address the condition's cosmetic and psychological effects. Liposuction and excision, or a combination of the two, are the two most common and effective procedures.
Patients who have mild to moderate gynecomastia, defined as breast enlargement with minimal gland hypertrophy and no extra skin, are excellent candidates for liposuction alone. Numerous people also have a little amount of fibrous glandular tissue behind the nipple, which can be treated directly with a minor incision around the areola. Power-assisted liposuction (PAL) or ultrasound-assisted liposuction (UAL) are particularly beneficial when doing liposuction for gynecomastia because they remove the fibrous tissue more effectively.
Severe cases may necessitate the use of more invasive methods. Gynecomastia that is severe requires not only liposuction but also skin excision to address the ptosis and extra skin. In many extreme situations, the nipple-areola may need to be temporarily removed and replaced with a graft in a more acceptable position on the chest following the removal of drooping skin and tissue.
Patients often wear bandages and support garments during the recovery phase to decrease edema and to support the chest while it recovers. Depending on the operation, a temporary tube may be inserted beneath the skin to drain excess fluid. Although patients will have edema for several weeks, the majority of patients will be able to resume normal activities within a few days.
The average cost of gynecomastia surgery in Mumbai in 2020 was approximately Rs 90000, and it should be noted that the procedure is not covered by the majority of insurance plans.
Gynecomastia Non-Surgical Treatments
While non-invasive treatments for gynecomastia are not as effective as surgical treatments, a recent study discovered three classes of medical treatments for gynecomastia: androgens (such as testosterone, dihydrotestosterone, and danazol), anti-estrogens (such as clomiphene citrate and tamoxifen), and aromatase inhibitors (letrozole and anastrozole). Many patients may not recover much following treatment.
Testosterone can be provided if a patient's testosterone level is abnormally low, and danazol, a synthetic type of testosterone that inhibits estrogen synthesis, may be somewhat beneficial. There is currently no effective medical treatment for gynecomastia.
Prior to resorting to prescription medicine, it may be prudent to address any underlying lifestyle problems that may be contributing to gynecomastia. The first step in treating gynecomastia is to address the underlying cause, assuming it is not hormonal in nature. This involves the cessation of any offending chemicals, such as pharmaceuticals or illicit drugs, the removal of a tumor, and the treatment of any underlying systemic disease.
The Take Home Message
Gynecomastia affects a substantial proportion of the male population over the course of a lifetime, and while the medical risks are modest, men with enlarged breast tissue may seek treatment to shrink their chest.
Whether patients choose liposuction, excision, or a mix of the two, gynecomastia surgery results are typically permanent. It is critical to highlight, however, that patients with gynecomastia caused by non-hormonal causes such as prescription medications, illicit drugs, or weight gain must maintain a healthy lifestyle. Consult with a board-certified cosmetic surgeon in Mumbai to determine the best course of therapy for guys.
Published by Dr Siddharth Prakash