Gynecomastia

Gynecomastia is enlargement of the breast gland in men, on one or both sides. It is very common: it appears in many boys during puberty and in a large share of adult and older men. Although almost always benign, it can cause discomfort, nipple tenderness and a significant impact on self-esteem.

What gynecomastia is

Gynecomastia results from an imbalance between oestrogens and androgens: when the effect of oestrogens predominates, glandular breast tissue grows. It feels like a firm, sometimes tender disc just under the areola.

Gynecomastia and pseudogynecomastia

Gynecomastia is not the same as pseudogynecomastia, a build-up of fat on the male chest due to excess weight, without growth of the gland. The difference matters because pseudogynecomastia improves with weight loss and is treated with liposuction, while true gynecomastia requires removing the gland. Often both are present.

Causes of gynecomastia

• Physiological: in newborns, during puberty (the most common, between 12 and 16) and in older men due to age-related hormonal changes.
• Medicines and substances: anabolic steroids, some prostate, heart or stomach medicines, antidepressants, alcohol and cannabis, among others.
• Diseases: liver, kidney or thyroid disorders and, less often, testicular or adrenal tumours.
• Idiopathic: in many adults no specific cause is found.

When gynecomastia goes away on its own

Pubertal gynecomastia resolves on its own in most boys within six months to two years, so surgery is usually postponed. If gynecomastia appears suddenly in an adult, is hard, is on one side only or comes with nipple discharge, a doctor should assess it to rule out other causes.

Treatment of gynecomastia

First, any cause is treated: stopping a medicine, correcting a hormonal problem or stopping steroids. When gynecomastia persists, the treatment is gynecomastia surgery:

• Removal of the gland through a small incision at the edge of the areola.
• Liposuction of the fatty tissue around the gland, usually combined with gland removal.
• In cases with a lot of excess skin, such as after major weight loss, the excess skin is also removed.

Recovery from gynecomastia surgery takes one to two weeks, with a compression garment for several weeks.