What is Gynecomastia?
Gynecomastia is the enlargement of breast tissue in males. All males have a very small amount of breast tissue. There are many reasons why this tissue can become enlarged. Many reasons are normal changes that occur throughout ones life and are a result of normal development and ageing and are self-limiting. In some instances the breast enlargement can be associated with underlying medical conditions that need to be treated.
What causes Gynecomastia?
Gynecomastia is the result of enlargement of breast tissue within a male breast. Normally Oestrogen levels are low in males. However, if there is an imbalance in hormones and the oestrogen levels are elevated or the ratio of Oestrogen to testosterone is elevated the breast tissue can enlarge.
Gynecomastia can result from the following causes:
- Normal physiologic changes (normal body processes).
- Medical conditions.
Normal physiologic gynecomastia
Can occur at various times throughout ones life and are normal and do not necessarily need any treatment. These include:
- Newborns – Female hormones can be passed to the unborn baby via the mother’s placenta. In these circumstances normal breast enlargement occurs and lasts for several weeks until the hormones are removed by the baby. This is not a problem that requires any treatment.
- Adolescents – This can occur from around the age of 10 and usually settles on its own by adulthood. This is a self-limiting condition. However, due to body image concerns surgery is sometimes indicated.
- Elderly – As one ages there is a natural decline in the testosterone levels and an increase in Oestrogen levels (due to increased body fat). This results in gynecomastia of elderly.
Underlying medical conditions
In a small number of cases (10-20%) there may be a serious underlying medical condition that is causing the gynecomastia. Before any surgery is undertaken these conditions need to be excluded. If an underlying medical condition is detected then your management will be guided towards treating the condition rather than treating the gynecomastia. In some instances the gynecomastia will resolve when the underlying medical condition is treated.
Possible underlying medical conditions causing gynecomastia include:
- Liver disease.
- Testicular Cancer.
- Kidney disease.
- Adrenal cancer.
- Lung cancer.
- Malabsorption conditions.
- Ulcerative colitis.
Medications causing gynecomastia
Unfortunately there are a large number of medications that patients are prescribed for many common medical conditions that ay have a side effect of causing gynecomastia. Your GP will be aware of these and will often warn you of this prior to prescribing the drug. Some drugs are essential and cannot be stopped. In these circumstances surgical intervention is likely to be recommended. In other cases the drugs are not essential (steroids used for muscle bulking) and treatment would be directed towards stopping the drug and seeing what happens.
Medications that can result in gynecomastia may include:
- Anabolic steroids.
- Testosterone deprivation medication – as treatment for prostate cancer.
- Fluid tablets (spironolactone).
- Blood pressure medication (verapamil, nifedipine, verapamil).
- Foods – some foods contain phytoestrogens.
Can gynecomastia be treated without surgery?
Gynecomastia is not a dangerous condition and as such does not have to have surgical correction. If the underlying cause is due to a medication or medical condition then the management will be directed towards that condition.
If the gynecomastia is due to excess Oestrogen or a deficiency in testosterone then the gynecomastia may be managed by adjusting the hormone levels. Low testosterone can be adjusted by regular testosterone injections, where as Oestrogen levels can also be lowered with medication. In these circumstance you may referred to an endocrinologist.
Gynecomastia that occurs naturally or due to a condition or medication that cannot be stopped may be treated with surgery. The reasons for offering surgery are usually due to body image or discomfort. The breast tissue can become painful and surgery is required.
What is involved in Gynecomastia Surgery?
Most gynecomastia surgery can be performed as a day case under a general anesthetic.
The operation involves what is known as a Subcutaneous Mastectomy for male gynecomastia. This surgery involves removal of all breast tissue on the chest, leaving normal body fat so as the chest contour returns to a normal flat shape.
The operation is performed via a circular incision around the nipple itself. Through this small window the entire breast tissue is removed. Under the nipple it is common for a small amount of breast tissue to be left behind. This is to avoid a collapsed divot with a sunken nipple that can occur if excessive tissue is removed. On the other hand if not enough tissue is removed then a recurrence in the gynecomastia is more likely.
In severe forms of gynecomastia there is also an excess of normal skin. If the excess skin is not removed at the same time the final result will be poor with a floppy skin that fills with fluid. In these cases a different type of incision is required so as the amount of skin can be reduced. This surgery will also often require the nipple to be repositioned. This is a more extensive operation for severe gynecomastia and may even require a two-staged approach.
What are the potential complications?
Gynecomastia surgery is a common operation performed by Dr. Green for which he has been well trained. The vast majority of patients will follow the “usual” path of recovery and be discharged from hospital feeling well either on the same day or the following day depending on the extent of the gynecomastia.
Despite this things may not always go according to plan and a small number of patients may experience a significant complication.
The information below will help you understand some of the possible problems that can result from having an operation on your breast. “Complications” are listed below. Some are common and others are less common but very important if they happen. While the following list is a guide, it is not comprehensive.
If you would like more information after your consultation and reading this page please feel free to discuss any issues with Dr Green.
Uncommon (up to 5% of cases)
Rare but important (up to 1% of cases)