Gynecomastia is the excessive development of the breasts in boys and men, which thus take on a feminine appearance. 
Gynecomastia can occur:

  • in children
  • in teenagers
  • in adults
  • in the elderly

Gynecomastia: the causes
In response to too much oestrogen (a female hormone) or too little testosterone (a male hormone), the gland tissue of the breast abnormally swells and enlarges the male breasts.

Male breast growth can begin during puberty, when hormone levels are changing. In these cases, gynecomastia does not last long, it passes without treatment as soon as hormone levels stabilise. 
The enlargement of the mammary gland in men can also begin in adulthood
As men age, they tend to lose testosterone and gain weight. 
Testosterone deficiency can cause gynecomastia
Excess weight adds adipose tissue, which tends to produce small amounts of oestrogen which can contribute to breast enlargement.

Although gynecomastia is an embarrassing problem, male breast growth is usually not a health problem.

However, in some men it can be a symptom of:

  • testosterone deficiency
  • overactive thyroid
  • cirrhosis of the liver
  • a genetic problem
  • certain types of cancer

Some medications can also cause gynecomastia. Among the most responsible are:

  • Anabolic steroids
  • Cimetidine
  • Spironolactone
  • Steroids, such as prednisone or dexamethasone.
  • Medicines used to treat epilepsy (such as phenytoin)
  • Digital and other heart medications.
  • Chemotherapy drugs, especially alkylating agents
  • Antiandrogen drugs
  • Anxiolytics and antidepressants
  • In many cases, it is enough to stop taking the medication to reverse gynecomastia.
  • Alcohol and marijuana abusecan contribute to the onset of gynecomastia.

In many cases, the exact cause is not clear. It is recommended to make an appointment with an endocrinologist to make sure that the breast growth is not related to health problems.

Types of Gynecomastia

Male gynecomastia is generally classified into:

  • pubertal
  • congenital
  • drug-induced

Pubertal gynecomastia
In adolescent boys, gynecomastia is caused by hormonal changes during puberty, it is usually temporary and regresses as soon as the hormones stabilise. If there is also an overweight problem, both weight loss and a healthy lifestyle help to reduce gynecomastia that is aggravated by localised fat accumulation.

Gynecomastia True or False:

  • True. Because of hormones
  • False. Excessive accumulation of adipose tissue
  • Mix. Hormonal causes and localised fat

It can be either unilateral or bilateral.

Gynecomastia: symptoms
Abnormal swelling is the main symptom. Men or boys affected by gynecomastia may notice that their breasts have an almost rubbery consistency. Typically, a coin-sized lump in the breast, shaped like a button, is present.

How is gynecomastia diagnosed?
Gynecomastia can usually be diagnosed through a physical examination and medical history. No specific tests are required, but if the lump in the breast is unusually large, unilateral, tender or hard and fixed in place, a biopsy may be required to rule out other conditions. 
Any unilateral breast lump should be analysed especially if there is history of breast cancer in the family
If there is no concern regarding cancer, a lump can be checked by biopsy or surgery.

Gynecomastia treatment
Gynecomastia in children and adolescents usually does not require treatment and disappears on its own.
If it is caused by drugs or an illness, as soon as you stop taking the drug or the illness passes, gynecomastia often disappears.
If gynecomastia is caused by a lack of testosterone and increased oestrogen, hormone treatment can be prescribed.
Surgery may be a choice for some men if other treatments have failed.
If the cause is overweight, weight loss is often the first step to take. If there is a lot of weight to lose then you will have to expect that the skin will be left toneless and sagging and then decide if you want to resort to a lifting operation. Plastic surgery is an option for this problem.

Surgical Treatments
The surgical options for male breast reduction are:

  • liposuction to remove fat
  • surgery to remove gland tissue

An aesthetic plastic surgeon must perform the procedure, which usually lasts between 60–90 minutes. 
This is an outpatient procedure, i.e. without an overnight stay, and often significantly improves the appearance of the chest.

The candidates for gynecomastia surgery can be those who:

  • have realistic expectations
  • are physically healthy and a normal weight
  • cannot use alternative medical treatments
  • whose breast development has stabilised
  • are non-smokers and non-drug users
  • are healthy individuals

Gynecomastia surgery reduces the size of the breasts and improves the shape of the chest.  
In severe cases of gynecomastia, the position and size of the areola can be surgically improved and excess skin reduced.  
Plastic surgery to correct gynecomastia is called reduction mammoplasty.

How to deal with gynecomastia
For a man, breast growth can be stressful and embarrassing. 
Gynecomastia can be difficult to hide.
During puberty, gynecomastia can create problems among one's peers. This frustration and embarrassment can be addressed and resolved. For example, you can:

  • Talk to a doctor who can help you avoid the discomfort of gynecomastia. It can also be good to talk about it with family, friends and partner.  
  • Meet people with the same problem. Talk to men who have had a similar experience can help.

There are a few factors that you can control so as to reduce the risk of gynecomastia, among them:

  • No use of drugs or illegal substances. For example: steroids, androgens, amphetamines, heroin and marijuana.
  • Avoid alcohol. Do not drink alcohol, or drink in moderation.
  • Medication. If you are taking medication that cause gynecomastia, you could ask your doctor if there are alternatives.

Although it may not be a health problem, gynecomastia creates a lot of discomfort and embarrassment.

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