According to a survey by Hospital Santa Virgínia, in São Paulo, about 40% of the Brazilian male population suffers from size changes in the breast region – a condition called gynecomastia.
The causes for the problem can be diverse, from the accumulation of fat caused by obesity to stages of life such as the passage through puberty
Contents
What is gynecomastia?
Gynecomastia consists of the swelling or enlargement of breast tissue in men , caused by the imbalance between the hormones testosterone and estrogen.
The condition may be due to an increase in the mammary glands ( true gynecomastia ), an increase in fat ( false gynecomastia ) or an increase in both (mixed gynecomastia).
What happens is that the lack or decrease in the production of testosterone, a hormone that gives male characteristics, allows estrogen to exert a greater influence on the development of female traits, such as breast growth.
Some factors can provide this hormonal dysregulation, such as changes in the body itself, the use of certain medications (such as antiandrogens used to treat enlarged prostate) and anabolic steroids.
In addition, the frequent and excessive use of alcohol and the consumption of fatty foods can also accumulate liquid and fat, favoring gynecomastia.
Read more: Exchanging animal proteins for vegetables reduces risk of disease
There are usually no associated symptoms. But when pain and secretions appear, gynecomastia can be indicative of pathological changes, such as tumors.
There are 4 degrees of gynecomastia, which can be diagnosed as grade 1, grade 2A, 2B and grade 3.
The specialist who can take care of and indicate the best treatment can be the general practitioner, plastic surgeon, endocrinologist or mastologist.
Depending on the degree, the indicated treatment can be oral, with the use of medications, or by performing surgery to remove breast fat.
There are also cases where nothing needs to be done, only follow-up, as the breasts return to their normal state.
Gynecomastia can be found in the International Statistical Classification of Diseases and Health-Related Problems, the ICD-10 , by the code:
- N62: Hypertrophy of the breast.
What is pubertal gynecomastia?
Pubertal gynecomastia is a condition that occurs with boys entering adolescence, in which hormones start to work harder for the development of the body.
What happens is that the hormones can become unbalanced, in this case the level of testosterone low and that of estrogen goes up, causing the growth in the breasts.
But this condition is reversed, in the vast majority, without the need for surgery or other therapies, because with time and sexual maturation, the hormones return to normal and the breasts gradually disappear.
Only in some cases, usually due to other diseases, such as obesity, may need therapeutic interventions
What is unilateral gynecomastia?
It is characterized as a condition of gynecomastia in which there is an enlargement of only one breast, one side being larger than the other.
The condition is, in general, less common than the bilateral condition (which affects both breasts), but the causes are the same and involve hormonal imbalance, in which the rate of testosterone falls and that of estrogen increases.
It is possible to reverse this situation without using medications or surgical procedures in many cases, just waiting for the body to develop and the hormones to act in the correct amounts.
However, as in the bilateral case, if the situation persists or severely affects the patient’s social life, treatments can be considered.
Causes
Gynecomastia can be triggered due to the decrease in testosterone in relation to the hormone estrogen or when the estrogen itself increases.
These changes can occur for different reasons, but generally the causes are:
Hormonal changes due to age
During the growth and development of the body, hormones do their part taking care of maintaining the female and male characteristics.
Both women and men have the hormones testosterone and estrogen. They are not exclusive to just one sex, but they are present in different measures: in men, there is more testosterone, and in women, more estrogen.
However, in some stages of life, when changes are involved, they can change the amount in the body.
By increasing estrogen in the male body, men have some characteristics that are more prevalent in women. Mainly in the phases:
Newborns
When babies are born their breasts may be larger, due to the influence of the estrogen inherited from the period in which it was in the mother’s womb. But after about 3 weeks of birth, the breast tissue disappears.
Puberty
In adolescence the body presents different changes, it is possible that in boys the growth of breast tissue occurs, but this occurs due to the swelling that disappears about six months to two years until the hormones stabilize.
Third Age
Just as women suffer in old age with the onset of menopause , men suffer from andropause . When there is a decrease in the hormone testosterone in relation to estrogen, which can cause an increase in the breasts.
Certain medications
Some medications can cause side effects in men, swelling breast tissue and forming gynecomastia. Among these medications are:
- Antiandrogens used to treat prostate enlargement, prostate cancer etc;
- Anabolic steroids;
- AIDS drugs;
- Anxiety medications, such as diazepam;
- Tricyclic antidepressants;
- Antibiotics;
- Ulcer medications, such as cimetidine;
- Medicines used in chemotherapy;
- Heart medications;
- Calcium channel blockers;
- Gastrointestinal motility medications, such as metoclopramide.
Diseases and changes in the body
Some diseases or conditions may have, as symptoms or consequences, breast growth in male patients. Between them:
Síndrome de Klinefelter
This syndrome occurs due to an error in the genes, right after conception. The man is born with an extra X chromosome (female), which provides greater characteristics of the woman’s body, such as breast growth.
Hipopituitarism
Hypopituitarism is a condition in which the body is unable to produce one or more hormones sufficient for the body to function properly.
In men, it can affect testosterone, making the hormone estrogen stand out, highlighting some female characteristics, such as breast enlargement.
Tumors
When a tumor settles in our body, it may show some symptoms of where it is located, in the breasts, for example, it may increase in size as it grows.
Cirrhosis
One of the factors of cirrhosis is the exaggerated and long-term consumption of alcohol, when cirrhosis settles in the patient, one of the possible symptoms is swelling of the breasts.
Hemodialysis
If the patient has a kidney problem, and hemodialysis is necessary, breast enlargement may occur. This is due to the different ways that hormones can behave in the patient’s body due to the performance of the procedure, which tries to contain them.
Drug’s use
Drugs like amphetamines, marijuana, heroin and methadone can cause gynecomastia.
Degrees of gynecomastia
Gynecomastia can be classified into four degrees, according to the type and growth of the breast, they are:
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Grade 1
It is characterized as a small breast enlargement, with emphasis on the areola region, in which there is no leftover skin, but it can bother the patient when using tight and more marked shirts, which can highlight the region.
Grade 2A
This grade has a moderate increase, but slightly higher than grade 1. In this case, there is also no leftover skin, but it is observed that the protrusion starts in the chest and not only in the breast.
Grade 2B
In grade 2B, gynecomastia usually causes a moderate breast enlargement, with excess skin, making the protrusion more apparent, even when wearing a blouse that is not tight.
Grade 3
When grade number 3 occurs, there is a large increase in the breast with the presence of excess skin. In this case, the condition is much more apparent than the others, being difficult to disguise.
Risk factors
Regarding the risk factors that can trigger gynecomastia, are:
Early adolescence
When adolescence begins, the body undergoes several changes due to the development of the body.
Hormones are responsible for the appearance of female or male characteristics. Due to normal phase changes, gynecomastia can occur.
Arrival at old age
When we reach old age, our body reduces the production of some substances, among them are hormones. In this case, testosterone reduces and estrogen (female hormone) starts to act more predominantly, which may result in a picture of gynecomastia.
Obesity or overweight
The consumption of food in excess and rich in fats does not only increase the weight, but also allows the breast tissues to grow, generating gynecomastia.
Read more: How to lose weight healthily: diet, exercise, medicine, menu
Use of anabolic steroids
The use of anabolic steroids, especially without medical advice, instead of helping can harm your health.
As the products contain hormones, irregular use can affect the body’s balance and cause side effects such as gynecomastia.
Liver and kidney diseases
Gynecomastia can be due to liver disease (which affects the liver) and kidney disease (which affects the functioning of the kidneys). Therefore, patients who have a history of changes in organ functioning are part of the risk group.
Excessive alcohol consumption
Alcohol has many calories, consuming this liquid in excess can generate the accumulation of fat in the body. In that case, there is only an increase in the fat tissue in the breasts.
But, in addition, alcohol has substances capable of stimulating hormonal changes, causing gynecomastia to develop.
Can women have gynecomastia?
No. Women may also have irregular breast enlargement or growth, but the condition is given another name: breast hypertrophy .
The problems in women’s breasts can be caused by several factors, such as diabetes , pregnancy, menopause, heredity, lumbar lordosis or pathologies.
Breast hypertrophy can be classified up to 4 degrees, which vary by the size and weight of the breasts in each woman.
Symptoms
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Breast enlargement, in general, does not affect the functioning of the organism and tends not to cause other symptoms, in addition to the characteristic breast enlargement.
Thus, it is noted that the breast or breast is larger than normal, as if it were swollen.
However, in some cases they may occur:
Breast sensitivity
Usually, the man does not feel pain in the breast or the sensitive chest, except in situations of impactful physical activities.
Asymmetric areola
Due to breast growth, the areola may change (the pigmented part that surrounds the nipple). Thus, the rounded shape can become asymmetrical, in the same way that changes in size can occur.
Nipple discharge
Nipple discharge is a worrying fact. When it appears in men, it is necessary to consult a doctor to assess the causes, since it is usually associated with diseases or changes in the body.
Itch
Feeling very itchy in the chest, especially in the nipples is one of the symptoms that can accompany the breast change.
How is the diagnosis made?
To make the diagnosis, the indicated professionals can be a general practitioner, plastic surgeon, endocrinologist or mastologist .
These four professionals are able to make the diagnosis and, for that, they will be able to ask questions about your family history, if by chance there were cases in someone close to you.
The professional can still request exams such as:
Bloodtests
The blood test helps to measure the level of hormones in the patient’s body, to see if they are altered. The exam order may include an assessment of the following hormone rates:
- FSH;
- Estradiol;
- TSH;
- Total testosterone.
In addition, analyzes of renal function and liver function may be ordered.
This test consists of taking a blood sample while the patient is fasting. After removal, the sample is sent to a laboratory for analysis.
The results help to investigate the possible causes of gynecomastia.
Mammography
The mammography can diagnose whether gynecomastia was caused by some tumors, lesions, cysts or when the patient has a lot of breast pain.
This examination can be done in two ways, the first is using a type of x-ray , in which the breast is exposed to the ray and an image is generated that will be stored in a film for later analysis.
The second way is when the breast is exposed to an x-ray that produces an electrical signal and transmits it to a computer for analysis.
Computed tomography
The computed tomography exam may be indicated, in order to be able to detail better what may have caused gynecomastia in more difficult cases of diagnosis. Tomography consists of an x-ray examination, in which the patient lies on a stretcher.
This mobile stretcher is transported into a kind of cylinder-shaped cabin. While the patient is lying down, the cylinder has an x-ray that produces internal images of the body.
Tissue biopsy
Performing a tissue biopsy will be able to assess the health of the breast tissue and identify the cause in greater depth.
Depending on the case, the biopsy must be performed with the patient sedated. For that, hospitalization is necessary.
After the patient is sedated, the doctor removes a part of the body tissue in the place where the problem presents itself, this living tissue is stored and sent to a laboratory for analysis.
In general, biopsy is requested when cancer or tumors are suspected .
Read more: Prostate cancer: hormone therapy increases risk of depression
Is there a cure?
-Yeah . Gynecomastia often regresses spontaneously and does not require therapeutic intervention. However, when necessary, there are procedures capable of reversing the condition, such as medication and surgery.
What is the recommended treatment for gynecomastia?
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In some cases, such as in adolescence and old age, surgery is not necessary. But, when it is necessary to carry out treatment with surgical intervention, there are two options: mastectomy and liposuction. The doctor will determine the best procedure based on the case:
Medicines
In some cases, drug therapy may be indicated, aiming to control hormonal changes or stop the progression of the condition. Medicines should always be used with close medical supervision.
Surgery
When there is no reversal of the condition or the breasts continue to develop for a period longer than 18 months, surgery can be indicated.
In general, the procedure can be done to remove the excess fat layers, the mammary glands or both (called mixed surgery).
Gynecomastia medications
In some cases, medications can be used to help reduce breasts, but when the satisfactory result is not obtained, surgery is indicated. The medications that can be used to treat gynecomastia are:
Androgens (testosterone replenishers)
As gynecomastia occurs due to the female hormone estrogen, testosterone and danazol replenishers can be used to assist in breast reduction work. It is indicated to use these drugs in elderly patients, with very low levels of testosterone.
- Testosterone ( Androgel , Deposterone , Axeron );
- Danazol (Ladogal).
Antiestrogens
Used to fight breast cancer , antiestrogens work by blocking the hormone estrogen. In some cases, they are used to decrease gynecomastia, providing a substantial improvement in this condition.
- Tamoxifen Citrate ( Festone , Novaldex , Taxofen );
- Citrato de Clomifeno (Clomid, Indux, Serophene).
Aromatase inhibitors
Aromatase inhibitors are drugs responsible for reducing the level of estrogen, the hormone responsible for breast enlargement in men.
- Anastrozol (Arimidex, Arazabi, Anastrozol);
- Exemestano (Aromasin);
- Letrozol (Femara, Letrozol).
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
How is surgery for gynecomastia?
The type of surgery will be determined by the cause of gynecomastia – whether it is due to excess fat, glands or both.
In some cases, it is also necessary to perform excision surgeries to correct problems in the areolas and nipples.
Regardless of the physician’s choice of surgery, these procedures may leave small scars, but the postoperative period tends to be quiet.
But some preoperative care needs to be performed.
The doctor in charge may order some tests, such as blood. In addition, sometimes weight loss can also be requested from the patient.
When the time comes for the operation, it may be necessary to apply local anesthesia with sedation or general anesthesia.
It is normal to feel a sore and swollen chest, but together with the recommended medications it is possible to control these discomforts.
The surgery lasts around 1 hour and it may be necessary for the patient to remain between 8 to 12 hours under medical supervision after completion.
Upon discharge, absolute rest is recommended, and you may gradually return to daily activities after 1 to 2 days, but it is necessary to avoid any physical effort for at least 30 days.
Surgical options include:
Mastectomy
This type of surgery is known to remove breast cancer tumors in women, but the same technique can be used to remove tissue from the male mammary glands. Small cuts are made around the areola, where the tissue that causes the enlargement of the breasts is removed.
Liposuction
Liposuction is a method that consists of the suction of fat through a small tube-like device. This tube sucks out all the fat that resulted in breast augmentation, after surgery there may be small scars on the chest due to the process.
Price: How much does gynecomastia surgery cost?
The values of a gynecomastia surgery vary widely, starting with the degree of the disease and the type of surgery. That is, whether it is liposuction or gland removal (each of these processes varies in cost).
In general, surgeries can start for R $ 3,500, and can reach up to R $ 17,000.
The ideal is to consult the plastic surgeon in your region, about what type of surgery needs to be performed in your case and then research the values in clinics and hospitals. There are cases where private health plans can cover the cost.
Living together
It is possible to live with cases of gynecomastia by acquiring some care, they are:
Avoid or restrict the use of medications that can cause gynecomastia
Medications such as antihypertensive drugs, drugs that treat gastritis , heart failure and male infertility can have the side effect of developing gynecomastia.
Pay attention to the package leaflet and if you notice any difference in your body, tell the doctor and avoid using the medication.
Take care of associated diseases
Some diseases can involuntarily provoke the appearance of gynecomastia, to avoid a case like this one must take care of the treatment of the condition.
The most common ones that cause breast enlargement are: liver cirrhosis, hypothyroidism , hypogonadism, some tumors such as in the testicles, liver and lungs.
Change eating habits
Consuming many high-fat foods promotes the formation of tissue that can develop gynecomastia.
Avoid overeating these fatty foods and alcoholic beverages, so as not to generate fluid accumulation and swelling that can facilitate the accumulation of fatty tissue in the breasts.
Prognosis
The prognosis of gynecomastia is positive in the vast majority of cases. Taking the right post-surgical care, the breasts tend to return to normal without damage. In cases such as puberty, gynecomastia tends to regress spontaneously over time.
Complications
Gynecomastia, in itself, does not cause any harm to the patient, when it is not associated with pathologies, such as cancer. However, surgical interventions are the most related to complications.
Although they rarely occur, they can cause:
- Scars;
- Bleeding (hematoma);
- Infection;
- Poor healing;
- Sensitivity changes in the breast or nipple;
- Accumulation of liquid;
- Irregular contour and shape of the nipple;
- Pigmentation changes;
- Swelling;
- Damage to deeper structures such as nerves and blood vessels;
- Allergies to suture materials used in surgery;
- Breast asymmetry;
- Adipose tissue necrosis;
- Cardiac and pulmonary complications;
- Pain that can endure;
- Need for a new surgical procedure (touch-up).
For patients who do not undergo surgical procedures and do not treat gynecomastia, it can cause complications such as:
- Problems of sociability;
- Low self-esteem;
- Emotional problems.
Read more: Breast cancer metastasis: the light may be to blame
How to prevent?
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It is possible to prevent cases of gynecomastia with some precautions, such as:
Avoid foods with fats
When we consume foods with a lot of fats, we encourage the increase of adipose tissue in the body, which stimulates the action of an enzyme called aromatase. It is related to the conversion of testosterone to estrogen (female hormone), which may favor gynecomastia.
Decrease consumption of alcohol and other drugs
As with food fat, alcohol has many calories that generate fat accumulation in the body. This stimulates the aromatase enzyme, which converts testosterone to estrogen, providing female characteristics.
In addition, excess alcohol compromises the liver’s functions, causing imbalance that can lead to breast enlargement.
In addition, some drugs, such as marijuana and heroin, when they enter our body produce an action similar to the hormone estrogen, which impairs the production of testosterone, promoting breast growth.
Caring for the treatment of associated diseases
When the patient has another disease, such as lung or testicular tumor, hypothyroidism, stroke, tuberculosis or kidney failure, he must always be attentive in health care.
These other pathologies or changes can deregulate the functioning of hormones and produce an increase in breast tissue.
Do not consume nutritional supplements without guidance
Supplements, especially aimed at gaining muscle mass, can stimulate hormonal changes. Therefore, the use should only be done under medical and nutritional guidance.
Common questions
Is gynecomastia in adolescence normal?
Yes , during adolescence it is normal for breast enlargement to occur in boys. In general, the condition normalizes without the need for treatments or interventions.
Is breast augmentation in men always bilateral or is there unilateral gynecomastia?
There is unilateral gynecomastia. Most cases occur in both breasts (bilateral), but some patients may experience breast enlargement on only one side. The treatment and conduct are similar.
Is there a remedy for gynecomastia?
In some cases, medications may be used to try to control hormonal changes. But, in most cases, if clinical intervention is necessary, the preferential treatment is surgery.
Gynecomastia decreases with the gym?
In general, no . In some cases, when the breasts are increased by body fat, exercise can help reduce it if there is a general weight loss.
However, weight training exercises can favor the muscular development of the chest, maintaining or even increasing the breast bulge.
Can gynecomastia return after surgery?
It is unusual, but it can occur. Especially in cases where the patient gains a lot of weight after months of the surgery or, also, if he has any disorder that can cause breast enlargement again, such as hormonal and metabolic problems.
Gynecomastia is a disease that can affect men at different stages of life, related to hormonal changes. Although there are no complications or serious symptoms, capable of compromising the patient’s health, the condition can bring social damage.
Therefore, when necessary, treatment can result in significant improvements to man’s routine and well-being.
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