It may seem like a harmless body image issue, largely benign without physical symptoms that could harm, but the psychological effects of extra breast tissue for men and boys can be devastating. According to the American Society of Plastic Surgeons (ASPS) and Dr. Brian I. Labow, author of a Boston Children’s Hospital study, even mild gynecomastia can adversely affect general health, social functioning, self-esteem and mental health. In his study of young males ages 12-21, many demonstrated increased levels of restlessness, loneliness, pain and tension, and some also developed eating disorders.
Seen primarily from a physical point of view, gynecomastia may appear fairly innocuous. In fact, only 1 in 1000 men will ever get breast cancer in their lifetime.
What is Gynecomastia?
The word, “gynecomastia” originates from Greek terms gynec meaning female and mastos meaning breast.
The medical condition Gynecomastia occurs when boys or men develop glandular breast tissue. Because of hormonal imbalances, inherited conditions, medical disorders, or certain medications, that tissue may continue to grow, forming one or both breasts.
Gynecomastia first presents as a small lump beneath the nipple. This is sometimes tender. As breasts begin to grow, one may become larger than the other.
When does Gynecomastia occur?
During a male’s lifetime, there are three distinct time periods when gynecomastia may occur. Each of these is associated with a time of great hormonal change.
Infancy—Newborn male babies develop breast tissue in 60-90% of cases, known as “transient palpable breast tissue”. Babies have circulating estrogen from their mothers for the first few weeks following birth. Gynecomastia regresses naturally however, within the first year of life.
Puberty—Between the ages of 13 and 14, between 4 and 69% of boys reportedly exhibit an increase in breast size where palpable breast tissue is detected. This can occur as early as age 10 and generally declines by age 17. An estimated 10% of 17-year old boys have persistent gynecomastia, however.
Middle age—Between the ages of 50 and 69, 70% of men have gynecomastia. This may be due to hormonal changes, when greater amounts of testosterone are converted to estrogen in midlife.
How is Gynecomastia diagnosed and classified?
Physicians first perform a physical examination to determine if true breast tissue, stemming from a nodule beneath the areola exists. Male breasts with a gynecomastia diagnosis appear in a pyramidal shape. Men without the medical condition possess fat tissue in the pectoral region with few ducts and stroma, unlike women where ducts, stroma and glandular tissue dominate breasts.
In research studies the condition is identified as having a subareolar palpable mass of breast tissue at least 0.5-2cm.
To determine if gynecomastia is present, physicians conduct a physical exam and may order specific tests to rule out certain medical conditions. These may include:
- Blood tests
- Liver function tests
- Hormone level/function tests
- Urine tests
In some cases an endocrinologist may be needed to further diagnose or treat gynecomastia.
Sometimes pseudogynecomastia may be diagnosed instead of gynecomastia. This is merely the accumulation of subareolar fat rather than glandular breast tissue. Because no palpable nodule is found, no treatment is necessary. In cases of true gynecomastia a tender, firm, mound of tissue must be found under the areola region.
Causes of Gynecomastia
Most of the time gynecomastia is a benign condition in males caused by hormonal changes in estrogen and testosterone. It can also be caused by certain medications for:
- Bodybuilding/anabolic steroids
- Heart conditions/cardiovascular medication
- Prostate cancer
Illicit drugs can also be linked to gynecomastia in men. These include:
A number of medical conditions can cause an increase in growth of breast tissue in men including:
- Liver disease
- Kidney disuse/ failure/dialysis
- Low levels of testosterone
- Congenital defects
- Adrenal gland tumors
- Pituitary gland tumors
- Klinefelter Syndrome (additional X chromosome(s)
- Lung cancer
- Testicular cancer
- Thyroid disorders
- Trauma or injury
Risks associated with Gynecomastia
While less than 1% of breast cancer cases involve men with gynecomastia, the condition does exist.
According to the American Cancer Society, about 2,470 new cases of invasive male breast cancer will be diagnosed in the U.S. this year. Some 460 men will die from the disease.
While breast cancer in men is relatively rare, signs and symptoms associated with the condition may include:
- Breast growth on one side
- Breast lump that is firm
- Sore skin over the breast
- Nipple discharge that is bloody
Early Intervention and Treatment for Gynecomastia
While gynecomastia is most prevalent in males during puberty, the condition usually resolves naturally within 2 to 3 years. In boys and men where glandular breast tissue does not diminish or continues to grow, early diagnosis and treatment is important.
Treatment methods may include one or more of the following:
- Cessation of certain medications
- Diagnosis and treatment of underlying disease processes
- Hormone therapy
- Surgical removal of breast tissue
The type of treatment a male receives is dependent on age, severity of condition, and primary cause of gynecomastia. In some cases, no underlying pathology may be found, however.
In (non-cancerous) situations where other treatment options are not viable, surgical removal of breast tissue may be an option. According to the ASPS however, breast reduction surgery for gynecomastia is frequently looked upon as “cosmetic” with only about 35% of health insurance companies covering the medical procedure. Sadly, all to often men are advised to simply “workout” or “lose weight”, which does not reduce the amount of true glandular tissue and excess skin in the pectoral region. For many, gynecomastia will continue to be a source of emotional pain, social anxiety, and body shame.
Finding the right medical professional to properly diagnose and treat the condition is critical.
1Blau, Mordecai, et al. “Anatomy of the Gynecomastia Tissue and Its Clinical Significance.” Plastic and Reconstructive Surgery Global Open, Wolters Kluwer Health, Aug. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5010345/. Accessed 21 Aug. 2017.
2“Breast enlargement in males.” University of Maryland Medical Center, www.umm.edu/health/medical/ency/articles/gynecomastia. Accessed 21 Aug. 2017.
3“Gynecomastia.” Gynecomastia – Health Encyclopedia – University of Rochester Medical Center, www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=P01118. Accessed 21 Aug. 2017.
4Johnson, Ruth E., and M. Hassan Murad. “Gynecomastia: Pathophysiology, Evaluation, and Management.” Mayo Clinic Proceedings, Mayo Foundation for Medical Education and Research, Nov. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2770912/. Accessed 21 Aug. 2017.
5Lemaine, Valerie, et al. “Gynecomastia in Adolescent Males.” Seminars in Plastic Surgery, Thieme Medical Publishers, Feb. 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3706045/. Accessed 21 Aug. 2017.
6Surgeons, American Society of Plastic. “Gynecomastia Has Psychological Impact on Adolescent Boys.” American Society of Plastic Surgeons, American Society of Plastic Surgeons, 2 Apr. 2013, www.plasticsurgery.org/news/press-releases/gynecomastia-has-psychological-impact-on-adolescent-boys. Accessed 21 Aug. 2017.
7“What Are the Key Statistics About Breast Cancer in Men?” American Cancer Society, www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html. Accessed 21 Aug. 2017.