Gynecomastia (man boobs)

Gynecomastia(sometimes referred to as “man boobs”) is a common condition where there is enlargement of breast tissue in boys and men. This condition is the most common reason for medical evaluation of the male breast.

It occurs transiently in many adolescent boys. Of these, in about 7 to 8 percent it persists.

Causes:

Most cases are idiopathic (occurring spontaneously without a known cause). The other causes include

  • Side effects of numerous medications and drugs of abuse such as corticosteroids, antibiotics, opioids (narcotic drugs), anti-anxiety medication, etc.
  • A medical condition such as kidney failure or liver disease, malnutrition and re-feeding (recovery from malnutrition), hyperthyroidism, etc.
  • Lumps or infection in the testicles
  • Alcohol dependence
  • Klinefelter syndrome (a rare genetic disorder)
  • Whatever the cause, it may affect either one or both breasts, many a time the breast enlargement is not equal and is more on one side than the other.

Signs & Symptoms

  • Enlargement of the male breasts
  • Tenderness and sensitivity
  • Pain

Diagnosis

Gynecomastia can be diagnosed by a physical examination.

Further evaluation is necessary in case of clinical examination revealing a cause such as a lump that is tender and of recent onset / progressive / of unknown duration. It is also advisable to evaluate a patient further in case of signs of malignancy (Eg: hard or fixed lymph nodes or positive lymph node findings)

Laboratory tests that may be considered include the following:

  • Serum chemistry panel
  • Hormonal assays- free or total testosterone, luteinizing hormone (LH), estradiol, thyroid-stimulating hormone (TSH) and free thyroxine levels

Other studies that may be helpful include the following:

  • Mammography/ Ultrasonography to clarify the nature of the breast enlargement
  • Testicular ultrasonography if clinical examination findings suggest the possibility of a testicular neoplasm
  • Karyotyping

Classification

Gynecomastia is classified into 3 grades based on factors like size of breast enlargement and feminization of the breast.

Management

In many cases of gynecomastia there is severe emotional distress and embarrassment leading to social withdrawal. There are instances of harassment from friends and peer groups which may lead to psychological issues.

In adolescents, a trial period of 2 to 3 years can be provided to observe for regression of the condition. Majority of them regress and resolve on their own.

In case of persistence of this condition, minimal scar treatment is an ideal option and can be done with good success rate. This is offered during the following situations or conditions -

  • People suffer from emotional distress, social stigma, social withdrawal, harassment due to gynecomastia
  • There is persistent increase in size of breasts
  • Diagnosis is doubtful
  • Symptoms like pain and tenderness are persistent

The procedure of minimal scar treatment for gynecomastia removal is done on an outpatient basis. The aim of this procedure is to remove the gland and surrounding fat with least scarring. The removal of surrounding fat is facilitated by ultrasound assisted techniques, this also helps in skin tightening.

In grade 3 gynecomastia, skin excision may be required to help skin tightening. The procedure of minimally invasive procedure usually gives long-lasting results.

We at Vikram Hospital have a experienced team of Plastic Surgeons who perform the minimally invasive procedure for gynecomastia with ultrasound assisted techniques.

The following images are from successful gynecomastia treatment -

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