Breast problems in men, although not uncommon, are less well known. They are often treated as taboo, with shame and discomfort by the patients themselves. Thus, few men will soon turn to a specialist mammologist when they notice a problem in their breasts. As a result, the relatively rare male breast cancer is usually diagnosed at an advanced stage. However, there is no cause for great concern, as only 1% of breast lumps in men involve breast cancer. The remaining cases are part of the gynecomastia. Early specialist examination is the only way to protect the man.
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What is gynecomastia?
Gynecomastia is the benign swelling of the male breast due to hypertrophy of the breast gland. Breast enlargement can also be caused by excessive fat accumulation, but then it is called pseudo gynecomastia. It is very common in adolescents and in men of advanced age. It requires proper investigation to rule out male breast cancer, initially, and investigate the aetiology, subsequently.
How common is normal gynecomastia?
Normal gynecomastia occurs at certain ages and is more common than you might expect. Over 70% of newborns have a swollen mass gland due to the mother’s estrogen. Due to the barrage of hormonal changes 40-50% of adolescents experience gynecomastia. These two types of breast enlargement are very likely to automatically regress over time. However, with increasing age there is a decrease in testosterone levels in men, resulting in gynecomastia in 50% of older men.
As we said, the actual swelling of the gland in the man should not be confused with the swelling of the breast position due to fat, called pseudo gynecomastia. This condition may accompany obesity in the man. Correct diagnosis is very important because pseudogynecomastia requires different investigation and has a different way of treatment.
What are the causes of gynecomastia
Gynecomastia when it is not normal, at a certain age, we ought to investigate the causes of it. It may be benign causes, but it may also be hiding very serious problems. Your doctor will guide you so that the tests needed are done in the right order. For your information we will mention some common causes of gynecomastia.
- Taking various medications for other diseases, such as prostate cancer
- Taking androgens (bodybuilding)
- Lavender and tea tree essential oils
- Hormonal disorders from other causes
- Thyrotoxicosis
- Kidney failure
- Liver disease
- Kidney tumours
- Genetic predisposition
Diagnosis and investigation of gynecomastia
With the appearance of swelling in the breasts, you should consult a qualified physician (breast surgeon – mammologist). The first priority is to rule out any breast cancer in the man. The clinical examination will give the first impression whether it is unilateral or bilateral gynecomastia (in one or both breasts) and also whether it is true or fatty gynecomastia. The whole body is examined to investigate the cause of the gynecomastia. This will be followed by radiological examinations such as breast ultrasound and mammography (depending on age). Blood tests, hormone tests and other tests are often required. The clinician will then evaluate all the findings and decide if a biopsy is needed to confirm the diagnosis. A guided biopsy via a cutting needle under local anaesthesia is the best way to make the diagnosis of gynaecomastia and rule out cancer. In rarer cases, biopsy may reveal other breast pathologies such as metastatic carcinoma, lymphoma, etc.
Which men should undergo biopsy:
- Hard and abnormal mass
- Mass not symmetrical in both breasts
- When there is nipple discharge (with or without blood)
- If the mass is not mobile from the skin of the nipple
- If the mass is attached to the chest wall
- When axillary lymph nodes are not normal
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Gynaecomastia and other diseases
If a condition is diagnosed during the investigation to reveal the cause of gynecomastia, the breast surgeon will refer you to the appropriate specialty. The most common referral is to an endocrinologist when hormonal imbalances are identified.
Gynaecomastia and breast pain
Many times gynecomastia is accompanied by severe breast pain. This causes significant problems in the man’s daily life, as it limits physical activity. If this is the case, the medical specialist will discuss with you the possibility of drug treatment to treat the pain. Medication for breast pain usually does not affect the swelling, so the treatment for gynecomastia is surgical.
The treatment of breast cancer with medical therapy is not sufficient to treat the condition.
Surgical treatment of gynecomastia
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Gynecomastia requires surgery to remove the mass gland and some of the fat behind the nipple. This procedure is called a subcutaneous mastectomy. If the gynecomastia is advanced, then oncoplastic surgery is required to reduce the excess skin. Depending on the size of the gynecomastia, the surgery can range from relatively short to long. These procedures are technically very demanding to achieve a good aesthetic result and require special skills from the surgeon.
It is a very special technique that requires a high level of skill and expertise from the surgeon.
Pseudogynecomastia, in which there is no gland but only fat, can also be treated with liposuction. Your doctor will advise you on the best way to treat your particular problem.
