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Gynaecomastia

Gynaecomastia (male breast) is an abnormal condition characterised by breast enlargement in males. Occasionally, they may also secrete milk. This condition may also be seen in neonates, adolescents and elderly individuals, as a part of physiological changes.

Gynaecomastia can affect either one or both breasts. Generally, gynaecomastia does not produce any harmful effect on the body but it may induce undue stress and embarrassment that can impact the active sex life of the affected individual. Male gynaecomastia can also cause psychological damage or loss of self-esteem in adolescents.

Causes of male gynaecomastia

Based on the physiological and pathological factors responsible for gynaecomastia, the common causes of gynaecomastia have been listed below:

Physiological

The physiological changes responsible for gynaecomastia are commonly seen in the following age groups:

  • Newborn: Due to the presence of maternal hormones circulating in blood
  • Adolescence: Due to hormonal changes which are temporary and may disappear as the hormonal levels stabilise
  • Increased age and weight: Production of testosterone declines with age while fat cells stimulate the secretion of female hormone oestrogen

Pathological

The various pathological causes of gynaecomastia are as follows:

  • Certain medication such as antipsychotics and anabolic steroids cause gynaecomastia as a side effect
  • Increased levels of oestrogen due to various conditions such as obesity, hyperthyroidism, malnourishment, adrenal tumours and testicular tumours
  • Decreased or lack of testosterone production due to conditions such as Klinefelter's syndrome, viral orchitis and renal failure
  • Chronic kidney or liver disease
  • HIV infection
  • Chronic illness

In some cases, gynaecomastia may be induced secondary to spinal cord injury or re-feeding after starvation; however, the underlying cause for this form of gynaecomastia remains unknown.

Diagnosis

The diagnosis of gynaecomastia includes a physical examination of the patient, by the physician. Occasionally, a mammogram may be ordered to exclude any other abnormality of the breast tissue. Certain blood tests may also be conducted to evaluate the underlying cause of gynaecomastia.

Treatment

The non-surgical methods employed for management of gynaecomastia include:

  • In case of drug induced gynaecomastia, replacement of the offending drug with an alternative and safer medication
  • Medical treatment of the underlying disease conditions causing gynaecomastia

In patients not responding to non-surgical options, surgery is considered as the last option. The surgical methods for management of gynaecomastia include:

  • Liposuction
  • Gland excision
  • Skin sculpture
  • Reduction mammoplasty
  • Combination of the surgical techniques mentioned above

The basic steps involved in surgery are as follows:

  • The surgery can be performed under general or sedation with local anaesthesia.
  • The patient is anaesthetised.
  • A small incision is made below the areola region of the breast.
  • Excessive breast tissue is surgically removed.
  • Excessive fat is removed by liposuction.
  • The incision is sutured.

Normally, the surgery takes about 90 minutes. After surgery, patients are often advised to wear an elastic pressure garment or ace bandage that promotes healing. Patients are also advised rehabilitation exercises for at least 3 weeks, and can return to normal activities in 6 weeks.

Complications

The possible complications associated with gynaecomastia surgery include:

  • Infection
  • Change in position or shape of the nipple
  • Numbness
  • Swelling
  • Bruising
  • Scarring
  • Haematoma (accumulation of blood)