Gynaecomastia or Male breast enlargement

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Causes of Gynaecomastia

1. Pubertal or physiological gynaecomastia- Some enlargement of the breast tissue happens in boys when they attain the age of puberty. This occurs because of the sudden increase in male hormone levels which are eventually converted into estrogen by fat cells in the body. This pubertal Gynaecomastia is physiological and most often doesn’t require treatment. It resolves after a period of few years on attaining adulthood when the hormone levels stabilise. Similar situation can occur in men over the age of 50 years with declining male hormone levels. This type of Gynaecomastia doesn’t subside on its own and may require treatment.
2. Obesity – leads to increase in fatty tissue which increases the peripheral conversion of testosterone to estrogen
3. Liver failure – leads to excess production of female hormones in the body and deficiency of male hormones
4. Excessive alcohol use – causes male hormone defeciency
5. Testicular atrophy or orchidectomy – causes male hormone defeciency
6. Certain medications and anabolic steroid use- causes hormonal imbalance due to conversion of excess testosterone to estrogen
7. Pseudogynaecomastia – in which excess fat is deposited in the pectoral area without overgrowth of glandular tissue. In this, there are no hormonal abnormalities and can be treated by liposuction or removal of the excess fat.

Grading of gynaecomastia

1. Grade 1 – Small enlargement, no excess skin
2. Grade 2 – Moderate enlargement, no excess skin
3. Grade 3 – Moderate enlargement with extra skin
4. Grade 4 – Marked enlargement with extra skin

Symptoms-

1. Enlargement or puffiness of breast which may be painful
2. Nipple discharge
3. Social embarrassment and anxiety
4. Low self confidence and poor self esteem

The psychosocial impacts of gynaecomastia are often greater than the physical disturbance. It may cause the person adopt a hunched posture, wear loose fitted clothes and avoid activities in which the upper body is exposed like swimming.

Treatment of Gynaecomastia

The treatment of Gynaecomastia will depend upon the cause and the clinical situation. In case of Gynaecomastia related to underlying disease or medication, the condition needs to be treated and the medication stopped or substituted. This will result in improvement in the enlargement of Breast tissue.

In cases of pubertal Gynaecomastia which persists into adulthood or which is not resolving with weight reduction and execrcise, it requires surgical treatment.

The surgery for Gynaecomastia can be done using a combination of liposuction using small cannula for removal of the fatty tissue and simultaneous gland removal by a small cosmetic incision placed around the areola. The recovery after surgery is quite rapid and patient can be discharged the same day or the next day. They can resume their routine activities after discharge and expect a complete recovery within 2 weeks. In cases of large Gynaecomastia, they might need to wear a compression garment for upto 6 weeks.

Post operative Care

Though recovery after gynaecomastia surgery is quite rapid, few precautions need to be kept in mind to avoid complications

1. Take a balanced diet and drink plenty of water for hydration
2. Avoid strenuous exercise and lifting heavy weights for 6 weeks
3. Avoid smoking and alcohol consumption
4. Wear compression garment for upto 6 weeks

FAQs

1. Is the gynaecomastia surgery painful ?
The surgery for gynaecomastia is done under local or genral anaesthesia depending upon the grade of enlargement. The surgery is not painful and pain killer medications are given in the post operative period to reduce the pain and swelling.
2. How long do I need to stay in the hospital and what is the recovery time?
The surgery for gynaecomastia can be done in the day care setting and usually the patient is discharged on the same day. They can resume normal activities within 2-3 days and can re join work taking all the necessary precautions.
3. Will the surgery leave a scar mark?
The surgery is done using very small puncture holes to remove the excess fat while the gland is removed by a cosmetically placed incision around the areola. This usually is not noticeable after the surgery and gives a good aesthetic outcome.
4. Can this problem recur after surgery?
If the glandular and fatty tissue are completely removed at the time of the operation, the problem usually doesn’t recur afterwards.
5. Can I do exercises and lift weights after the procedure?
A recovery time of 6 weeks is recommended before the person can do any type of strenuous exercise. Afterwards, they are allowed to do any type of work out which would further enhance the cosmetic outcome of the procedure.