Gynecomastia

What is gynecomastia?

Gynecomastia is a condition which causes enlarged male breast tissue. It appears as a small growth underneath the nipple. The lump may move within the breast tissue and can be tender. This condition can occur in one or both breasts.

Although you may not have heard of the term Gynecomastia, male breast enlargement is a very common condition that can affect men of any age. The Men’s Health Program at Cleveland Clinic Abu Dhabi observed that gynecomastia is the most common reason for breast health related visits to the clinic.

Gynecomastia is a serious condition that can affect men’s confidence and self-image. It can also be a manifestation of malignancies in the breast or other organs in the body. The General Surgery Department at Cleveland Clinic Abu Dhabi offers comprehensive clinical evaluation for men with this condition, including history and examination, a full range of blood work up and imaging tests, all together aim to diagnose hormonal imbalances and rule out any possible malignant conditions leading to develop gynecomastia.

What causes gynecomastia?

Gynecomastia can be caused by lots of things, but it is usually the result of a hormone imbalance (an imbalance of testosterone and estrogen). Men usually produce a small amount of estrogen, which controls breast growth, but if too much is produced, or the level of testosterone is low, the breast tissue can enlarge.

Excess fatty tissue in obese people can also cause enlarged breasts – this is called pseudo-gynecomastia.

Gynecomastia usually occurs in:

• Newborns: As many as half of all male babies have enlarged breasts, due to elevated estrogen levels from the mother. The condition disappears after a few weeks.
• Puberty: Many adolescents have breast enlargement due to a fluctuation in hormones, such as dropping testosterone levels and surging estrogen. It can take up to 2 years for the levels to even out.
• Older males: The condition is more common in men over 50, caused by a drop in testosterone. A higher percentage of body fat may also stimulate estrogen production.

Other causes of gynecomastia

There are other conditions which can cause breast enlargement in men:

• Kidney failure
• Liver failure
• Klinefelter syndrome
• Thyroid disease
• Tumors in the adrenal glands
• Tumors in the testicles
• Tumors in the liver
• Tumors in the lungs

Gynecomastia can also be a side effect of certain medications used to treat:

• Anxiety and depression
• Bacterial and fungal infections
• Enlarged prostate
• Heartburn
• Heart failure
• Hypertension
• Male infertility
• Stomach ulcers
• Anabolic steroids

Diagnosing gynecomastia

A doctor will first discuss symptoms and medical history, and then perform a physical examination. A blood test will be ordered to check your hormone levels and to identify any endocrine imbalances.

Depending on the age of the presentation, a breast ultrasound with or without a mammogram will be performed to rule out breast cancer or pre malignant lesions. Gynecomastia can also be a sign of other cancers in men, including testicular, liver and lung cancer, so your doctor may order further tests to rule these conditions out. These further investigative tests may include imaging tests, scrotal examinations to rule out testicular cancer, tumor marker blood tests, and hepatic and renal function tests.

Treating gynecomastia

If a medication or another condition are causing the breast enlargement, then your doctor will discuss alternative medications or disease treatment. Early grades of gynecomastia can be self-resolving and require no treatment. On the other hand, advanced cases will require removal of the excess breast tissue to help reduce the symptoms.

Gynecomastia surgery aims correcting this male chest deformity to improve the confidence and self-image of many men with the condition. It can also alleviate chronic symptoms like pain and nipple discharge.

Cleveland Clinic Abu Dhabi’s General Surgery Department has a vast experience in gynecomastia surgery and well-developed comprehensive program for male breast health. This program offers a wide spectrum of surgical options tailored for each particular case.

The surgery may also be referred to as subcutaneous mastectomy and can be done with or without liposuction depending on the individual. Complex skin reducing procedures to treat co-existing redundancy can be offered for advanced cases.

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