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.

Causes

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
• Obesity
• Gynaecomastia can also occur as a result of alcohol abuse and the use of marijuana.

Risk Factors

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.

Disease Progression

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