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Gynaecomastia is the medical term for what is commonly known as Man boobs.
Puffy Nipples means the same entity, so are moobs, man-breasts, bumpers, headlamps, boy-knockers, mantits, wobblies, bazookas, moobies, chesticles, tipples, mammary glands, love lumps and, the ever-popular, “bitch tits.”
As you can see, the problem with gynaecomastia is psychological and not a physical one. It is embarrassing for a male to be associated with female organs.
1. What is Gynaecomastia?
Gynaecomastia is the enlargement of male breast tissue. Gynaecomastia appears as a rubbery or firm mass that starts from underneath the nipple and then spreads outwards over the breast area. It is not cancerous.
The tissue is enlargement of glandular tissue, not fat tissue. Enlargement is found in both breasts in about half of cases, while in the other cases it only affects one breast.
Gynaecomastia can happen in males of any age or weight. The growth of breast tissue can be painful or tender. A doctor should always check painful gynaecomastia. Gynaecomastia can appear as a small lump that becomes tender as the mass becomes larger. It is common in adolescent boys as breast development is affected by hormonal changes at puberty. This can cause psychological stress.
2. How common is Gynaecomastia
Gynaecomastia is very common in boys going through puberty, happening in more than half of all normal adolescent males, and usually goes away over time. In older men, enlargement of the breast tissue happens in about one-third of men, who often have excess surrounding fatty tissue as well.
3. What causes Gynaecomastia?
Gynaecomastia is commonly seen during infancy, puberty and older age.
All males have the male sex hormone testosterone as well as low levels of the female hormone oestrogen, which controls breast tissue growth. When the ratio of testosterone to oestrogen changes (that is, there is an imbalance in the levels of these two hormones with relatively higher amounts of oestrogen), breast tissue can grow. Some men with gynaecomastia have higher than normal oestrogen levels.
During mid to late puberty the maturing testis makes more oestrogen than testosterone until the time when the testes start to make testosterone at adult levels. Gynaecomastia starting during puberty often goes away, but in less than one in 20 adolescent boys, it continues into adulthood.
As men get older there is often a gradual decrease in testosterone levels (and therefore the ratio of oestrogen relative to testosterone goes up) and this can lead to gynaecomastia.
Medicines that can cause breast growth in men include certain antidepressants, medicines used for high blood pressure and tuberculosis, and some chemotherapy agents. Antibiotics and cardiovascular medicines and a specific anti-ulcer medicine (cimetidine) can sometimes change the balance of hormones in the body.
Drug abuse, especially the use of anabolic steroids, but also marijuana, opioids and excessive alcohol intake (that has caused chronic liver disease) can cause gynaecomastia.
Medicines used in the treatment of prostate cancer that block the effects of testosterone (androgen deprivation therapy) can lead to gynaecomastia.
A special mention is needed for bodybuilders on cyclical steroids. Unregulated use is a common cause for glandular gynaecomastia and loss of sexual drive.
4.How is Gynaecomastia Diagnosed?
A doctor can examine the enlarged breast tissue to check whether it is gynaecomastia or excess fat. In true gynaecomastia, a rubbery or firm mound of tissue the same shape as the nipple can be felt. If breast enlargement is due to fatty tissue, there is no round shaped disc of tissue.
Once a diagnosis is made, it is important for the doctor to review all medicines the man may be taking that could be linked with his gynaecomastia. No further testing may be needed if the underlying cause is clear and/or no action is required. For example, in a pubertal boy with a family history of gynaecomastia or in an older man whose breast enlargement has been there for a long time.
However, if an otherwise healthy man has a short history of quickly enlarging and/ or tender breast swelling he will need a blood test for sex hormones and blood markers of testicular cancer, along with a testicular ultrasound; however, testicular cancer is very uncommon and not likely to be the cause.
If there are irregularities or lumps in the breast, mammography, breast ultrasound or MRI may be helpful. If there are any suspicious findings a biopsy can exclude the rare but serious diagnosis of breast cancer
5. Types and grades of Gynaecomastia
There are two common types
- True Gynaecomastia (Due to enlargement of the gland below the nipple +/_ fat)
- Pseudo Gynaecomastia (Due to accumulation of fat)
Obese men can look like they have man boobs as they have fat tissue all over the body including the breasts; however, this is not true gynaecomastia
The American Society of Plastic Surgeons recognizes 4 types of Gynaecomastia
- Grade One – Mild enlargement of the breast bud concentrated behind the areola
- Grade Two – Breast growth spreading beyond the areola with edges that blend with the chest wall
- Grade Three – Breast growth spreading beyond the areola, with clear edges and redundant skin
- Grade Four – Marked breast enlargement with redundant skin and feminisation of the breast
6.Why should Gynaecomastia be treated?
Embarrassment and Psychological issues: Gynaecomastia is usually not life threatening but it can affect a man’s quality of life. For example, men may avoid swimming or taking their shirts off to avoid embarrassment. Few men openly discuss their concerns with their local doctor or family and can become distressed about body image. Gynaecomastia can be particularly embarrassing for adolescent boys. Teasing by peers is relentless and often quite ruthless. People should understand it as a part of the normal processes of puberty and aging, and there may be further research into treatments.
Pain: Painful Gynaecomastia should always be treated.
7. How is Gynaecomastia treated?
Treatment of gynaecomastia depends on the underlying cause, whether the condition is expected to continue, and cosmetic concerns. Watching for further development is usually the best option in pubertal cases as in most cases gynaecomastia goes away over time.
If a cause is found and treated during the first phase of growth, the breast enlargement may be stopped and reversed. If it’s because of medicine or drug use, the enlarged breast tissue has caused gynaecomastia will usually go away within a month of stopping the medicine.
Medical treatments are used to treat Painful gynaecomastia and in Early onset gynaecomastia.
Several medicines have been tested to treat gynaecomastia in men who have no underlying hormonal problem, although the success rates are different in each study. The use of medicines to block the action of oestrogen, increase testosterone and alter the oestrogen- testosterone balance can help to reduce gynaecomastia in some men.
Tamoxifen, a medicine used in breast cancer, is not approved to treat gynaecomastia but may help in some men. However, in others, there may be no benefit and the side-effects of tamoxifen include possible deep vein thrombosis (blood clot).
Other drugs which are useful include Danazol and Aromatase Inhibitors.
Surgery is the mainstay of treatment and the surest way to completely eliminate the problem. In most cases, its quick, easy and has a very high degree of patient satisfaction.
The type of surgery depends on the grade of gynaecomastia, age and skin quality of the patient and expectations.
Liposuction is a component of all methods of gynaecomastia treatment. Liposuction only is performed for soft/fatty glands and when the patient does not want any scar around the nipple. It works well for Grade 1 and 2 fatty gynaecomastia and reduces bulk in Grade 3 and 4 gynaecomastia. Liposuction also contours the rest of the chest and avoids a step off deformity.
Gland excision is performed along with liposuction for all patients who have a fibrous gland. This completes the removal and makes the surgery recurrence free. We perform a specialized Transareolar removal of the gland which minimizes the visible scar. This can be done in bodybuilders/models who need to expose.
In Grade 3 and 4 patients, although much of the stretched skin from gynaecomastia will adjust with time after surgery, especially if pressure garments are used, sometimes the excess skin needs to be removed. This can be done in a single stage in most patients. We perform a single stage composite nipple repositioning and areola reduction surgery which can give immediate and gratifying results.
8. Can Gynaecomastia recur after treatment?
In some cases, where the original cause of gynaecomastia is continued (e.g Steroids without medical supervision), or when Liposuction alone is used to treat the problem, a change in the hormonal milieu can cause the gland to grow again. It is highly unlikely that the gland can regrow after a complete glandular excision has been performed.
9. What’s the aftercare for gynaecomastia treatment?
We advice wearing a pressure garment for 6-8 weeks. Scar treatment may be needed in some patients.
10. Bodybuilding and Gynaecomastia: is there an increased chance of developing gynaecomastia?
This is one of the commonest causes of the spike in cases seen now. Anabolic Steroids are being openly procured and distributed by gym trainers without medical supervision. Intense peer pressure and the desire to quickly gain muscle mass makes young adults receptive to these suggestions. Most of these work on increasing the androgen level in the body, but our body has an innate balancing mechanism when one range of hormones is suddenly increased artificially, it starts production of the opposite balancing hormone, in this case, estrogens which are derived from testosterone by a process called aromatisation.
This causes the gland to start growing rapidly and because of the low subcutaneous fat cover, quickly becomes visible.
It can be avoided by careful dosage and supervision. A graded start, close monitoring and a careful post cycle treatment comprise the pillars of regulated anabolic steroids. Selective Estrogen Receptor Modulator (SERM) is the first line of defense in a comprehensive PCT and plays an important role in post cycle therapy for gynecomastia by preventing the actions of estrogen.
Aromatise Inhibitors forms the next crucial element in post cycle therapy for gynecomastia. The main role of aromatise inhibitors is to prevent the process of aromatisation or the conversion of male hormone testosterone into female hormone estrogen.
SERM’s, on one hand, mitigates the risks, side effects and working of estrogen already built up in your body due to steroid use whereas, AI’s try to prevent further production of estrogen from testosterone through the process of aromatisation, hence the name aromatase inhibitors.
Both these drugs are used for the treatment of Breast Cancer patients and have a variety of side effects. These should only be started by a medical professional with the right qualifications.
In addition, there is a chance that post cycle therapy for gynaecomastia will not work as intended and this can be due to a number of reasons. The main problem in such cases is that a lot of time has passed since the steroids were used and the excess breast tissue that had been formed have been set well into your body. Post cycle therapy for gynaecomastia will also have to be discontinued for a minority of users due to high and serious levels of side effects. Another group would be those who are taking medications that will have contraindications for (meaning they do not go well with) SERM’s and AI’s. In all these cases, post cycle therapy for gynaecomastia will not be effective.
If you are unable to continue with post cycle therapy or if it simply does not work for you even after trying, then the only logical option you have is to go for gynaecomastia surgery.
Gynaecomastia surgery is the fastest and guaranteed way you can get rid of gynaecomastia.