Gynecomastia is swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone. Gynecomastia is an endocrine system disorder in which a noncancerous increase in the size of male breast tissue occurs. Gynecomastia can affect one or both breasts, sometimes unevenly. Newborns, boys going through puberty and older men may develop gynecomastia as a result of normal changes in hormone levels, though other causes also exist.
The development of gynecomastia is usually associated with benign pubertal changes. However, 75% of pubertal gynecomastia cases resolve within two years of onset without treatment.
Generally, gynecomastia isn’t a serious problem, but it can be tough to cope with the condition. Men and boys with gynecomastia sometimes have pain in their breasts and may feel embarrassed.
Gynecomastia does not mean that someone has extra fat from being overweight. It is caused by additional breast tissue. Doing exercise or losing weight will not reduce the breast tissue in gynecomastia.
Pseudogynecomastia is separate condition, where fat builds up in the breasts, possibly due to being overweight or obese.
Treatment options for gynecomastia
Gynecomastia normally resolves without any treatment, but if there is an underlying condition, it may need treatment.
If the condition stems from a medication, the patient may need to switch to a different drug. If the patient is using the medication for a short time only, the condition will be temporary.
If the condition does not resolve within 2 years, or if it causes embarrassment, pain or tenderness, treatment may be necessary.
Treatment is rare. Options include breast reduction surgery or hormone therapy to block the effects of estrogens.
Mild cases of gynecomastia in adolescence may be treated with advice on lifestyle habits such as proper diet and exercise with reassurance. In more severe cases, medical treatment may be tried including surgical intervention. Most cases of gynecomastia regress over time without treatment. However, if gynecomastia is caused by an underlying condition, such as hypogonadism, malnutrition or cirrhosis, that condition may need treatment. If you’re taking medications that can cause gynecomastia, your doctor may recommend stopping them or substituting another medication.
In adolescents with no apparent cause of gynecomastia, the doctor may recommend periodic re-evaluations every three to six months to see if the condition improves on its own. Gynecomastia often goes away without treatment in less than two years. However, treatment may be necessary if gynecomastia doesn’t improve on its own or if it causes significant pain, tenderness or embarrassment.
Medications for the treatment of gynecomastia
Medications for the treatment of gynecomastia . Selective estrogen receptor modulators (SERMs) such as tamoxifen, raloxifene, and clomifene may be beneficial in the treatment of gynecomastia but are not approved by the Food and Drug Administration for use in gynecomastia.Clomifene seems to be less effective than tamoxifen or raloxifene. Tamoxifen may be used for painful gynecomastia in adults.Aromatase inhibitors (AIs) such as anastrozole have been used off-label for cases of gynecomastia occurring during puberty but are less effective than SERMs.A few cases of gynecomastia caused by the rare disorders aromatase excess syndrome and Peutz–Jeghers syndrome have responded to treatment with AIs such as anastrozole. Androgens/anabolic steroids may be effective for gynecomastia. Testosterone itself may not be suitable to treat gynecomastia as it can be aromatized into estradiol, but nonaromatizable androgens like topical androstanolone (dihydrotestosterone) can be useful.
A number of medications can cause gynecomastia. These include:
- Anti-androgens used to treat prostate enlargement, prostate cancer and some other conditions. Examples include flutamide, finasteride (Proscar, Propecia) and spironolactone (Aldactone).
- Anabolic steroids and androgens.
- AIDS medications. Gynecomastia can develop in HIV-positive men who are receiving a treatment regimen called highly active antiretroviral therapy (HAART). Efavirenz (Sustiva) is more commonly associated with gynecomastia than are other HIV medications.
- Anti-anxiety medications, such as diazepam (Valium).
- Tricyclic antidepressants.
- Ulcer medications, such as cimetidine (Tagamet HB).
- Cancer treatment (chemotherapy).
- Heart medications, such as digoxin (Lanoxin) and calcium channel blockers.
- Gastric motility medications, such as metoclopramide (Reglan).
The amelioration of enlarged male breasts is removing fat and or glandular tissue and, in extreme cases, excess skin. The outcome is that the thorax is flatter, firmer and better contoured. The candidates for surgery have firm, elastic skin that will regulate to the body’s new contours. If chronic gynecomastia is treated, surgical removal of glandular breast tissue is usually required. Surgical approaches to the treatment of gynecomastia include subcutaneous mastectomy, liposuction-assisted mastectomy, laser-assisted liposuction, and laser-lipolysis without liposuction. Complications of mastectomy may include hematoma, surgical wound infection, breast asymmetry, changes in sensation in the breast, necrosis of the areola or nipple, seroma, noticeable or painful scars, and contour deformities. Radio Therapy and tamoxifen have been shown to help prevent gynecomastia and breast pain from developing in prostate cancer patients who will be receiving androgen deprivation therapy. The efficacy of these treatments is limited once gynecomastia has occurred and are therefore most effective when used prophylactically. In the United States & India many insurance companies deny coverage for surgery for gynecomastia treatment or male breast reduction on the basis that it is a cosmetic procedure.
Gynecomastia is the most common benign disorder of the male breast tissue. New cases of gynecomastia are common in three age populations: newborns, adolescents, and men older than 50 years old. Newborn gynecomastia occurs in about 60–90 percent of male babies and most cases resolve on their own. During adolescence, up to 70 percent of males are estimated to exhibit signs of gynecomastia. Senile gynecomastia is estimated to be present in 24–65 percent of men between the ages of fifty and eighty. The prevalence of gynecomastia in men may have increased in recent years, but the epidemiology of the disorder is not fully understood.
The use of anabolic steroids and exposure to chemicals that mimic estrogen in cosmetic products, organochlorine pesticides, and industrial chemicals have been suggested as possible factors driving this increase. According to the American Society of Plastic Surgeons, breast reduction surgeries to correct gynecomastia are becoming increasingly common. In 2006, there were 14,000 procedures of this type performed in the United States alone. Working through the incision, Dr. Nagwani cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions resulting in more conspicuous scars. If liposuction is used to remove excess fat, the cannula is usually inserted through the existing incisions.
In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the remaining skin to firmly readjust to the new contour.
Gynaecomastia surgery usually takes about 1 hour or more.
If chronic gynecomastia is treated, surgical removal of glandular breast tissue is usually required. Surgical approaches to the treatment of gynecomastia include subcutaneous mastectomy, liposuction-assisted mastectomy, laser-assisted liposuction, and laser- lipolysis without liposuction. Complications of mastectomy may include hematoma, surgical wound infection, breast asymmetry, changes in sensation in the breast, necrosis of the areola or nipple, seroma, noticeable or painful scars, and contour deformities.
Two gynecomastia surgery options are:
- Liposuction. This surgery removes breast fat, but not the breast gland tissue itself.
- Mastectomy. This type of surgery removes the breast gland tissue. The surgery is often done endoscopically, meaning only small incisions are used. This less invasive type of surgery involves less recovery time.
More extensive Reparation may be performed under general anaesthesia.
Risk Factor may include:
- Kidney or liver disease
- Alcohol abuse
- Radiation treatment of the testicles
- Klinefelter’s syndrome
- Tumors of the testes, adrenal or pituitary gland
- Hyperthyroidism and hormonally active tumors.
There are a few factors you can control that may reduce the risk of gynecomastia:
- Don’t use illegal drugs. Examples include steroids and androgens, amphetamines, heroin, and marijuana.
- Avoid alcohol. Don’t drink alcohol, or drink in moderation.
- Review your medications. If you’re taking medication known to cause gynecomastia, ask your doctor if there are other choices.
Gynecomastia is not physically harmful, but in some cases it may be an indicator of other more serious underlying conditions, such as testicular cancer. The glandular tissue typically grows under the influence of hormonal stimulation and is often tender or painful. Furthermore, gynecomastia frequently presents social and psychological difficulties such as low self-esteem or shame for the sufferer. Weight loss can alter the condition in cases triggered by obesity, but losing weight will not reduce the glandular component and patients cannot target areas for weight loss. Massive weight loss can result in sagging chest tissue known as chest ptosis.
Frequently Asked Questions
- Who are not the best candidates for the surgery to correct Gynaecomastia?
- Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, individuals who drink alcoholic beverages in excess or smoke are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause Gynaecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option.
Facial Cosmetic Surgery-Feminization of face
Facial expressions allow us to interact and communicate with each other. Our appearance also has an impact on how others perceive us, so many people try to always put their best face forward.
Some individuals would like to improve certain aspects about their face. Others are born with facial abnormalities such as a cleft lip, a birthmark, or other birth defects and desire correction. Many of us notice the effects of aging, sun damage, or previous facial trauma on the face. Fortunately, many of these conditions can be corrected through procedures performed by a surgeon