Everything you need to know about Gynecomastia

Gynecomastia or male breast enlargement is the most common benign condition of the male breast and accounts for up to 80% of male breast referrals. Prevalence of asymptomatic gynecomastia is reported as 60-90% of neonates, 50-60% of adolescents, and 70% in men aged 50-69. That means, at certain phases of life with significant hormonal fluctuation (shortly after birth, puberty, „manopause”) gynecomastia may be a natural and temporary response. 

But what is exactly gynecomastia and what is the pathophysiology behind it? 

Rozina Ali, a top-rated plastic surgeon highly qualified in breast surgery, shared with us some useful insights about the most common symptoms, surgical methods alongside the recovery process and post-surgery results of gynecomastia. 

What is Gynecomastia?

Gynecomastia is a condition that makes breast tissue enlarge in boys and men. It can happen when the balance of two hormones (oestrogen and testosterone) in your body is thrown off. If men have enlarged breasts because of excess that is different if a related condition called "pseudo gynecomastia". 

Especially in pubertal males, gynecomastia often goes away on its own within about six months, so observation is preferred over surgical treatment in such age range cases. Stopping medications that can cause gynecomastia and treatment of existing medical problems or health conditions that cause enlarged breasts in men also are mainstays of GP treatment.

Causes and symptoms of gynecomastia

Gynecomastia can stem from an imbalance between the sex hormones testosterone and oestrogen. Oestrogen, the “female” hormone, makes breast tissue grow, while testosterone, the “male” hormone, stops oestrogen from making breast tissue grow.

Between 10-20%  of cases are thought to stem from the use of medication or herbal products, and 25 per cent occur for unknown reasons.

All males and females have both testosterone and oestrogen, but testosterone occurs in higher proportions in males, while females have higher levels of estrogen. Whether we think of newborns, adolescents or adults, the primer cause of gynecomastia is a relatively low testosterone level.

The first sign of gynecomastia may be a lump of fatty tissue under the nipple. Sometimes this lump is tender or sore. This might make you worry that you have breast cancer. Gynecomastia is not a sign of cancer, but your GP may run some tests to rule it out. Swelling of the breasts may happen unevenly, with one becoming larger than the other. You may also have breast tenderness.

Treatments and surgery

In cases where hormone levels are out of balance because of another health problem, treatment of that underlying condition is advised. 

In some cases, you might need surgery, and the most common techniques are Liposuction (removal of extra breast fat) and breast tissue excision using a peri-areolar incision. Liposuction requires a small 3-5mm diameter cannula to be inserted from the axillary area (armpit) to suction away excess fat.

Excision of the breast ‚disc’ beneath the areola requires a small peri-areolar incision measuring and open excision of the breast tissue 

To make sure you are suitable for gynecomastia surgery, we recommend a consultation with your plastic surgeon

Recovery

The recovery time after gynecomastia varies with every patient and the type of activity you intend to resume. While the incisions made during surgery are very small, liposuction creates a large ‘degloving’ wound under the skin. A surgical compression vest is therefore vital to help your tissues stick back down in place and heal.  Healing is a gradual process, so adequate rest in the days after surgery is essential. Sleeping with your upper body slightly elevated to help quicken any reduction in swelling and bruising.

Typically, you can expect to be back at work within days of surgery, resuming light exercise within 2-6 weeks. You should avoid any strenuous upper body exercise for at least 3 weeks after surgery. It is very common to have some bruising, swelling and minor initial lumpiness to the area after surgery.

You may feel numb or tingly in some areas due to some nerve irritation. This is usually resolved within the first 6 months of surgery, so the final routine check-up should take place around 6 months after surgery.