What is Gynecomastia?

Gynecomastia refers to the development of breasts in men. The word Gynecomastia has a Greek origin that means “women-like breasts.” A torment for many males, it affects 40 to 65 percent of adolescent males and approximately 10 to 15 percent of adult men. Ancient Egyptian sculptures have depicted men with large breasts. Even the famous philosopher, Aristotle, is reported to have had Gynecomastia. The earliest known writings describing the surgical treatment of Gynecomastia via removal of male breasts were dated as early as 690 A.D.

“My doctor told me to ignore the problem because it would go away. But the torment that I suffered from the time I developed breasts at age 12, until I finally had surgery this year, was constant. My classmates nicknamed me “Boobs.” Some even called me “Bitch Tits,” which was mortifying. I was embarrassed to wear any fitted clothing. Girls offered me their bras. I was terrified to date. It was only when I had my breasts reduced this year that I started to feel okay about my body.” — Jack, age 33

Yet, Gynecomastia only recently truly came out into the open. According to the American Society of Plastic Surgery, the number of surgical procedures to correct Gynecomastia increased nearly 50 percent from 1997 to 2001, the year that a reported 16, 512 men underwent the procedure. This placed Gynecomastia surgery in the top five of the most common plastic surgery procedures performed on men. The website www.gynecomastia.org gets 100,000 visits each month worldwide, showing the prevalence of concern about this condition.

No longer do physicians tell men to “just live with” Gynecomastia. In fact, Male Breast Reduction is being increasingly performed for all groups of men who suffer from Gynecomastia. They no longer need be embarrassed by wearing form-fitting shirts, t-shirts, or even avoid taking off their shirts at the pool or the beach!

What Is Gynecomastia?

Gynecomastia is the condition of abnormally overdeveloped and enlarged breast tissue in men. In Greek, gyne means “woman” and mastos means “breast.” The Gynecomastia can affect either one, or both, breasts, to differing degrees. It is caused, not only by an increase in “adipose” (fatty) tissues, but also by the hypertrophy or overgrowth of the glandular breast tissue, as well.

What Are The Symptoms of Gynecomastia?

In one third of the cases, Gynecomastia is “unilateral,” appearing in just one breast. For reasons that are unknown, unilateral Gynecomastia tends to be more common in the left breast.

Usually, Gynecomastia presents as a marble-like lump under the nipple of the breast, which then leads to large, swollen areolas – the colored area around the breast. In more serious cases, this can lead to “C” or “D” cup breasts, made of both breast tissue and fat. The overdeveloped breast gland can actually produce milk which presents as a small amount of staining on a teenager’s shirt.

Other symptoms include water retention, due to an increase in estrogen levels. Also, there are times when there is associated breast pain or tenderness.

What are the classifications of Gynecomastia?

In the 1930′s, Gynecomastia was classified into three categories. One was glandular, referring to an overabundance of thick glandular breast tissue as opposed to fatty tissue. In this case, surgical removal of the breast gland is required.

A second type is “fatty glandular,” where there is a combination of fatty and glandular breast tissue over-development. In such cases, surgery is combined with Liposuction for better contouring of the breast.

The third type is “simple fatty” where very little fibrous breast tissue exists, so that breasts can simply be reduced in size with Liposuction.
Periods of Abnormal Breast Development in Males:

There are three periods of life during which time abnormal breast development or Gynecomastia can occur:

  1. Neonatal period— An estimated 60 to 90 percent of infants have transient Gynecomastia, caused by the mother’s estrogen. Although this is something that first concerns all new parents, it is not a reason for alarm and generally resolves completely by the time the infant is one year old.
  2. Puberty Period— Normal hormonal changes during puberty stimulate breast growth. Gynecomastia developed during puberty affects up to 65 percent of boys, even as early as 10 years of age. In a majority of cases, breast tissues regress to normal size by the end of puberty. However, in about 10-15% of cases, Gynecomastia persists into adulthood.
  3. Geriatric Period— Men after the ages of sixty can experience a reduction in body Testosterone levels, leading to the development of breast tissue, testicular atrophy, and loss of libido.

What are some of the Diagnostic Tests for Gynecomastia?

In addition to a complete medical history and physical examination, you will probably undergo blood tests for liver function, hormone levels, thyroid function and urinalysis. A physician such as an endocrinologist who specializes in hormonal issues will analyze your tests and examinations in order to determine the underlying causes of Gynecomastia. There are times when further testing including CT scan, PET scan, and even biopsies are used to assist in making a diagnosis. Fortunately, a majority of cases of Pubertal Gynecomastia are benign and do not need any medical treatments.

Are There Conditions That Mimic the Appearance of Gynecomastia?

Psuedogynecomastia is a condition where obese boys and men retain excess adipose or fatty tissue in their chest, giving them the appearance of having developed breasts. However, this is distinct from Gynecomastia in that the buildup of adipose tissue is not localized only to the breast area, but involves the entire chest. Another distinguishing feature of Psuedogynecomastia is the lack of firm sub-areolar glandular breast tissue.

Because Psuedogynecomastia is caused by obesity, usually weight loss will resolve the problem. In those with extremely large breasts, or with long-lasting and irreparable Psuedogynecomastia, surgical treatments include Liposuction, Liposuction-assisted breast reduction, or even mastectomy.

Does Having Gynecomastia Mean that I Have Developed Breast Cancer?

Often, men with Gynecomastia fear that they have developed breast cancer. However, this is almost never the case. Breast cancer can develop in men as well as in women. Its incidence is estimated to be 0.2 percent of all malignancies in men, and it is not associated with Gynecomastia. Thus far, clinical studies have failed to show any relationship between breast cancer and Gynecomastia, although drug-induced Gynecomastia, and Gynecomastia caused by long-term exposure to estrogen are believed to increase the risk of breast cancer in men. Unlike Gynecomastia, breast cancer in men generally presents as a unilateral firm mass, and is often not centered beneath the areola in contrast to the case of Gynecomastia.

However, mature males who develop Gynecomastia in one breast should be alert to the possibility of Breast Cancer, and be examined by their physician, who will probably recommend testing, before proceeding with cosmetic surgery.

Dr. Younai is a Board Certified Cosmetic Plastic Surgeon who is experienced in all treatments for Gynecomastia- Male Breast Reduction and Liposuction. During your consultation he will discuss all details including: if you are a good candidate, surgical options and techniques, potential risks and complications of surgery, pre- and post-operative instructions, and recovery course, as well as what to expect after surgery. At that time Dr. Younai will also show you before-and-after pictures of other patients who might be similar to you with Gynecomastia and have had Male Breast Reduction.




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