Signs and Symptoms
Gynecomastia is a disorder that causes enlargement of the male breast tissue. One or both the breasts can be affected. Symptoms include:
- The enlarged breast can feel rubbery or firm to touch.
- The swelling may appear as a breast lump.
- At times, the affected breast tissue may be tender or painful.
- It causes the breasts to sag and the areola (dark coloured skin around the nipple) to be stretched.
The following are the possible causes of gynecomastia:
Hormonal imbalance: This is the most common cause of gynaecomastia. It is caused by an imbalance between oestrogen (female hormone) and androgens (male hormones). Oestrogen, the hormone that governs breast growth, is produced at modest levels by men's bodies. However, if there is excess oestrogen production or much less androgen, the male breasts tend to grow in size.
Medicine: Medications that affect hormones can also cause gynaecomastia. These include heart medicine, amphetamines, anabolic steroids, and chemotherapy drugs. Medicines used to treat stomach ulcers, depression, high blood pressure, and prostate cancer can also enlarge breast tissues.
Medical conditions: Male breast growth can be caused by a variety of medical conditions, including:
- Liver disease
- Thyroid disease
- Klinefelter syndrome (a rare genetic condition)
- Kidney disorders
- Adrenal tumours
- Lung cancer
- Gynaecomastia can also occur as a result of alcohol abuse and the use of marijuana.
The following are the risk factors for gynaecomastia:
- Children having symptoms of gynecomastia that last after their first birthday are more likely to develop pubertal gynaecomastia later in life.
- Patients with alcoholic liver disease are more prone to develop gynaecomastia.
- High oestrogen levels increase the risk for gynaecomastia in men.
- Mutation in the aromatase gene (responsible for oestrogen synthesis) that leads to excess oestrogen in many families (fathers and sons) increases the risk of gynaecomastia.
Myths vs Facts
1. Myth: Medicines can be used to treat gynaecomastia.
Fact: To date, there are no medicines that can help treat gynaecomastia.
2. Myth: When left alone, gynaecomastia causes no harm.
Fact: Untreated gynaecomastia slightly increases the risk of breast cancer in men.
Prevention and Disease Reduction
You must remember the following:
- Gynaecomastia caused by hormonal imbalance cannot be prevented.
- Switching drugs (linked to increased breast growth) or seeking treatment for a substance abuse disorder may help you lower your risk of breast growth.
When to See a Doctor?
Seek medical attention if your gynaecomastia causes the following symptoms:
- Discharge from nipple
- Breast lump
- Unusual changes in the breast
- Pain in the breast
- Itchy breasts and underarms.
Risks if not Treated in Time
The risk of gynaecomastia includes the development of breast cancer. Men with this condition have a slightly higher risk of developing breast cancer in the future.
Gynaecomastia can be graded in the following manner:
- Grade 1: Minimal hypertrophy (less than 250 g of breast tissue) without ptosis
- Grade 2: Moderate hypertrophy (250-500 g of breast tissue) without ptosis
- Grade 3: Severe hypertrophy (more than 500g of breast tissue) with grade 1 ptosis
- Grade 4: Severe hypertrophy with grade 2 or grade 3 ptosis
Hypertrophy: Enlargement of organ or tissue cells.
Ptosis (in the breast): Drooping of breast tissue
If you're concerned about swollen male breasts, the first thing you should do is consult your doctor. Your doctor will examine you and gather a history of your health and medications. The doctor may order the following test:
- Blood test to check your hormone levels.
- Ultrasound of breast: To see detailed photos of your breast growths.
- Mammogram: A mammogram is used to look for abnormal growth or alterations in the breast tissue.
- Biopsy: In this case, a small sample of the breast tissue will be removed and checked for the presence of cancer cells.
The treatment options are as follows:
- If your enlarged breast tissues are caused because of taking certain medications, then stopping or switching to a different drug may improve the gynaecomastia. Consult your doctor before stopping any medication that is used to treat other health conditions.
- If a particular medical condition is a reason behind your gynaecomastia, then treating that condition will improve your breast size.
- Hormone replacement therapy (HRT) can be used to manage gynaecomastia. This helps to balance the hormone levels.
- In rare cases, surgery is suggested to remove the excess breast tissue.
- Gynaecomastia surgery is a procedure that decreases the size of a man's breasts while also flattening and improving the chest contours.
- The extra breast tissue can sag and strain the areola in severe cases of gynaecomastia. The location and size of the areola can be addressed surgically in these circumstances, and the extra skin will be removed.
Figure: Before and After Gynaecomastia Surgery
How to Prepare for the Doctor Consultation?
You may follow the below tips:
- Know the main reason behind your doctor's appointment and what you would like to accomplish from that visit.
- Make a list of the questions you'd like addressed.
- Bring someone along to assist you in asking questions and remembering what your doctor says.
During the appointment, the doctor will:
- Enquire about your medical history and present complaints.
- Physically examine the affected area.
- Advice regarding any investigation that is required to make the correct diagnosis.
Ask the following questions to your doctor:
- What caused my gynecomastia?
- Is it necessary for me to switch drugs to prevent breast enlargement?
- What is the treatment approach for me?
- How can I keep my breasts from enlarging again?
- Should I get a breast cancer screening?
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