Gynecology And Obstetrics-

Gynecomastia

definition

The term gynecomastia refers to the occurrence of, as a rule, benign enlargements of the mammary gland in men. In general, gynecomastia is not an independent disease. This enlargement of the mammary glands in men is rather a possible accompanying symptom of various systemic diseases.

It can also be used in the course of treatment drug the male breast increases in volume. In these cases it is a so-called adverse drug effects.
In general, from a medical point of view, a distinction is made between two forms of gynecomastia, the real and the false gynecomastia:

The false gynecomastia is caused by pure fat deposits in the breast tissue (for example through strong Obesity or in the normal sense Aging process).

True gynecomastia is the multiplication of Glandular tissue.

Such changes in the breast area represent major problems for the affected man. Most patients find the female breasts embarrassing and unsightly, which is often the result mental problems and an increasing social withdrawal. The presence of gynecomastia also has an increasingly disruptive influence on the partnership and self-confidence.

Which doctor treats such a thing?

Men who notice that their breasts are growing should definitely consult a doctor who can clarify the causes and rule out a malignant disease. The family doctor or urologist takes a detailed anamnesis (medical history) and can forward the patient to the respective specialist. An endocrinologist (hormone doctor) carries out a special blood test to ascertain the hormone status, since an unbalanced hormone balance is often the cause of gynecomastia. A gynecologist or radiologist examines the breast using ultrasound (breast ultrasound) to rule out cancer. Once the diagnosis of real gynecomastia has been confirmed and the patient would like to have the excess breast tissue surgically removed, a plastic surgeon performs the procedure.

to form

In medicine, changes in the male breast are divided into two classes. One speaks of so-called normal (physiological) and morbid (pathological) Changes. The class of physiological increases in breast volume includes:

Neonatal gynecomastia: female hormones of the mother that are released through the placenta (Plaster cake) get into the organism of the unborn, trigger an increase in glandular tissue.
The excess breast tissue usually disappears completely within the first few months after the birth.

Puberty gynecomastia (see below): It occurs in the course of the enormous change in hormones during adolescence and is caused by the increased conversion of hormone precursors into female sex hormones (Estrogens) triggered.
This form of gynecomastia does not resolve completely in all affected boys.

Geriatric gynecomastia: This type of gynecomastia is also induced by changes in the hormonal balance. In contrast to pubertal gynecomastia, however, this change is related to the increasing proportion of adipose tissue compared to the decreasing body mass.
As a result, the conversion of male sex hormones that takes place in adipose tissue increases (Androgens) into female hormones (Estrogens). As the concentration of estrogens within the organism increases, so does the number of androgens. This fact is mainly related to the decreasing functionality of the testicles.

Overweight: This can also lead to an increase in volume in the breast area. In these cases, however, it is not an increase in glandular tissue but rather fatty tissue deposits.

Pathological (pathological) Increases in breast volume are all included in the group of true gynecomastia. So it is about "Growths“Of the glandular tissue, not about fatty tissue deposits.

Pathological gynecomastia itself is not a disease, but merely a symptom of a disorder within the organism. The trigger can be a lack of male sex hormones (Androgens) or an excess of female hormones (Estrogens) be.

Chronic diseases such as acute and / or chronic kidney failure, kidney insufficiency, liver failure and alcohol addiction can also stimulate the growth of the mammary gland tissue in the long term.

In addition, real gynecomastia can occur as an undesirable drug effect in the course of drug therapy. Relevant drugs include hormone preparations, acid blockers (for example cimetidine, ranitidine and omeprazole), Calcium channel blockers, some neuroleptics and many other drugs.

In addition, in very rare cases, the presence of a tumorous change in the breast (Breast cancer) lead to an increase in glandular tissue in men.

Enlarged breast from alcohol or beer

Long-term alcohol abuse leads to men losing their typically masculine appearance and having enlarged breasts. Excessive alcohol consumption can lead to inflammation of the liver and eventually cirrhosis, in which the liver becomes hardened and can no longer function normally. As a result, certain hormones are no longer broken down and testosterone is increasingly converted into female sex hormones. Alcohol also inhibits the secretion of sex hormone-producing hormones in the brain, which means that there is generally less testosterone in the body. In addition, alcohol activates an enzyme (Aromatase), which converts male into female sex hormones and thus leads to an excess of estrogen. As a result, men “feminine” and develop gynecomastia.

in the puberty

Very often young men are affected by gynecomastia during puberty, this is referred to as puberty gynecomastia. More than 60% of all gynecomastia cases affect adolescents during puberty. This is a standard variant, as the hormone balance is disrupted by the beginning of the production of sex hormones during puberty. Testosterone is produced in men from estradiol, the precursor of the female sex hormone estrogen. In some cases, the concentration of estradiol can rise faster than that of testosterone and thus the effect of estradiol, which stimulates the growth of the mammary gland, predominates. Testosterone has the opposite effect.

Puberty gynecomastia can occur on one or both sides and usually resolves spontaneously within two to three years. In rare cases, however, it can persist and manifest as true gynecomastia. Puberty gynecomastia is not a disease and does not require treatment. However, especially at this sensitive age, an enlarged breast can cause severe emotional stress for the adolescents concerned and be associated with high levels of suffering.

With bodybuilders

Gynecomastia is common in strength athletes and bodybuilders who take anabolic steroids or testosterone to build muscle. In these cases, the cause is hormonal. Testosterone can be converted into estradiol, a female sex hormone, in the body. Estradiol causes the mammary gland to increase in size and gynecomastia occurs.

causes

The causes of an increase in breast tissue (Gynecomastia) can be diverse and differ between the different types. In almost all forms of this increase in breast volume, however, the hormonal system plays a crucial role.

In many cases there is an increased responsiveness of the mammary gland tissue to female sex hormones, the estrogens. In addition, an increased concentration of estrogens within the organism can stimulate the glandular tissue to grow. These increases in concentration can in turn be caused by pronounced metabolic disorders, diseases of the Pituitary gland (Pituitary gland and or Hypothalamus) or Hormone therapies to be triggered.

Please also read our page Pituitary tumor.

Also taking Anabolic steroids can lead to the formation of gynecomastia. In addition, gynecomastia can also occur in the course of puberty or if one is present estrogen-producing testicular tumor be provoked.

In addition, male sex hormones can also have an influence on the growth of the mammary glands. Here, however, an androgen deficiency plays a decisive role in the development of gynecomastia. The decreased production of male sex hormones can be the result of an underactive testicle or age-related. In addition, diseases of other organs can be the cause. These gynecomastia inducing diseases include one Overactive or underactive thyroid, one Cirrhosis of the liver or a disorder of kidney function. Regardless of organ defects, the ingestion of high amounts of hormones through food can lead to the development of gynecomastia. The consumption of in particular plays a decisive role hormone treated meat. A bilateral increase in breast tissue can be attributed in the majority of cases to one of the reasons just mentioned. However, if there is unilateral gynecomastia, the presence of a tumor (breast cancer; breast cancer) must be ruled out.

Read about it too How do you recognize breast cancer in men?

What drugs cause gynecomastia?

Taking drugs that affect the hormonal balance can lead to the formation of gynecomastia. Active substances that inhibit male hormones, such as those used in the treatment of testicular cancer or prostate tumors, or therapy with female hormones stimulate breast growth.

However, other medications can also lead to gynecomastia as a side effect. These are e.g. Spironolactone, a drug that is used to increase water excretion and as a blood pressure lowering agent, digitalis preparations (heart medication), H2 blockers (stomach protection), chemotherapeutic agents, opiates, psychotropic drugs, antidepressants, anabolic steroids, steroids and various drugs such as heroin and amphetamines.

treatment

From a purely medical point of view, if true gynecomastia is present, no surgical therapy is generally necessary. For most of those affected, however, such an increase in breast tissue results in severe psychological impairment. In many cases, affected men lose an enormous amount of self-confidence and their appearance is increasingly embarrassing. The result is a steadily increasing social withdrawal. Living together with the partner also usually suffers from the presence of gynecomastia. In such cases a surgical removal of the excess breast tissue can greatly improve the patient's quality of life. Surgical correction is usually carried out via a small incision in the area of the areola through which access to the Glandular tissue is created. The increased tissue can then simply be suctioned off (in the same sense as with an ordinary Liposuction). However, in any surgical procedure, it should be remembered that gynecomastia is merely a symptom. For this reason a Search for the cause be initiated. Only with appropriate treatment of the underlying problem can a renewed increase in the mammary gland tissue be prevented. Because of this, other crucial measures are included in the treatment of gynecomastia. Every affected patient is advised to change their lifestyle, especially their eating habits. It should also be long-term Weight reduction and renouncing alcohol be sought. At Drug-dependent gynecomastia must be switched to an alternative medication if possible. Is there a lack of male sex hormones (Androgens), then a Hormone replacement become necessary.

Home remedies for gynecomastia

Just a fake or Pseudogynecomastiathat has too much fat build-up in the breast can be self-treating. There are no real home remedies, but a lot of exercise, endurance sports and a healthy diet or diet can reduce the percentage of body fat and thus lead to an improvement in gynecomastia. In addition, anabolic steroids and growth hormones should not be used in weight training, as these promote breast growth. If there is no improvement despite these measures, it is probably true gynecomastia. A doctor should then be consulted to clarify the hormonal status and possible causes of the breast enlargement. Home remedies do not help here, as only an operation can permanently remove the enlarged mammary gland.

Which drugs help against gynecomastia?

A real gynecomastia can be caused by a messed up hormone balance. A doctor can do a blood test to determine the hormone status and, if necessary, prescribe medication that rebalances the hormonal balance and thus prevents the progression of gynecomastia. However, the administration of medication does not always lead to an improvement; the last step is then the surgical removal of the excess mammary gland tissue.

Possible causes of gynecomastia are either too few male hormones (Androgen deficiency) or too many female sex hormones. An androgen deficiency means that fewer male sex hormones, especially testosterone, are produced. This deficiency can be replaced by giving sex hormones as part of hormone replacement therapy. Men also produce female sex hormones, which serve as a precursor to the production of testosterone. However, too high a production of female sex hormones can lead to an increase in breast tissue and gynecomastia. In such cases, drugs to inhibit estrogen or testosterone directly can be administered. An excess of the hormone prolactin also has a stimulating effect on breast growth and can be treated with dopamine antagonists.

How does an operation work?

The process of a Andromastectomy (Breast correction) for modeling a flat man's breast depends on whether the patient suffers from real gynecomastia, i.e. a pathological increase in the breast tissue, or from a false pseudogynecomastia in which only excess fatty tissue has accumulated in the breast. A mixed form between the two types of illness is also possible.

In a preliminary talk, the plastic surgeon will discuss the procedure with the patient and explain exactly how he will proceed. With true gynecomastia, the doctor usually chooses to remove the entire mammary gland to prevent it from growing again after surgery. The operation takes place under general anesthesia or, in the case of a minor procedure, also under local anesthesia. Depending on the patient's condition, different methods are used: liposuction, removal of the glandular tissue or a combination of gland removal and liposuction. The doctor will make one or more incisions in the areola and cut out excess breast tissue and possibly also fatty tissue. In some cases this also comes Ultrasound-assisted aspiration lipectomy (UAL) is used, in which excess fatty tissue is liquefied by ultrasound and suctioned off.

With general anesthesia, the patient is admitted to the hospital and can usually be discharged the next day. After-effects of the operation include pain, bruises, swelling and numbness, which disappear after a few weeks. In addition, the patient has to wear a bodice for several weeks after the procedure, which keeps the now flat chest in shape and supports the healing process.

What does an operation cost?

The cost of an operation for the surgical removal of a gynecomastia varies from person to person, as the price depends heavily on the patient's condition, the size of the enlarged breast and the effort involved.Normally you can expect costs between 2,000 and 3,000 euros.

Who bears the costs for an operation?

The removal of an enlarged male breast is in most cases a purely aesthetic operation, the costs of which are borne by the patient alone. The cost of liposuction is usually not covered by health insurance. However, if the doctor confirms that the operation is necessary from a medical point of view, the health insurance company will cover the entire cost or grant a subsidy. Especially men who suffer from real gynecomastia with an increase in breast tissue are at an increased risk of breast cancer. In such cases, the health insurance pays the surgery costs.

What scars will remain after the operation?

The scars that result from gynecomastia removal depend on the patient's initial condition (real or fake gynecomastia) and the method used during the operation. In general, however, only very small scars develop, which heal well and are then barely visible. When the mammary gland tissue is removed, a small incision is made in the areola, which is almost invisible after it has healed. With liposuction, only small punctures are made in the fold under the breast, which also hardly leave any scars.

Can you train gynecomastia away?

Spurious pseudogynecomastia caused by too much fat in the breast can be reduced through exercise. If, despite weight reduction and training, there is no improvement, then it is a real gynecomastia with enlarged glandular tissue. Sport and physical activity do not help in this case, since excess mammary gland tissue cannot be exercised away. Surgical intervention to reduce the breast is the only way to remove the annoying male breast.

To reduce pseudogynecomastia, the body fat percentage must be reduced. This works best through endurance sports and conditioning training such as running and swimming alternating with muscle training. Men who are overweight and have enlarged breasts should seek advice from a gym, where their body status can be assessed and an individual training plan can be created. In order to get a nice flat man's chest, one should first try to reduce the percentage of body fat and then the pectoral muscle (M. pectoralis major and M. pectoralis minor) to be built up specifically through weight training.

Paradoxically, however, not only overweight men but also well-trained athletes can have an enlarged mammary gland. Weight training combined with the use of steroids and anabolic steroids changes the levels of hormones in the body and stimulates breast growth. Stopping the medication may cause the enlarged breast to recede. Therefore, the use of such supplements should be avoided when doing weight training.

Read more on the topic: Muscle building and anabolic steroids

What is the difference to lipomastia?

With a so-called Lipomastia too much adipose tissue leads to enlargement of the male breast. Especially in overweight men with an increased body fat percentage, one often forms Lipomastia. This is a bogus or Pseudogynecomastia, since the breast enlargement is only caused by fat deposits and not by a pathological increase in mammary gland tissue. A mixed form between lipomastia and gynecomastia is also possible Lipogynecomastia. Lipomastia can be treated by reducing the percentage of body fat or, in severe cases, by liposuction.

More symptoms

Gynecomastia can affect one or both sides, causing the mammary glands to swell. In some cases there is also increased fat tissue stored in the breast, which makes the tissue soft and can hang down ("man's breasts"). The enlarged mammary glands can be very sensitive to touch, but only rarely do they cause pain to those affected. The chest can feel firm and tense. The nipple area in particular is often extremely sensitive and fluid may leak out. Gynecomastia is a symptom and not an actual disease, so the side effects vary depending on the cause of the enlarged breast. Gynecomastia is not dangerous and therefore does not require treatment, but since symptoms are very similar to breast cancer in men, it is essential to see a doctor if the breast is overgrowth. The doctor makes the diagnosis of gynecomastia and can rule out a pathological finding with high-resolution ultrasound of the breast and possibly also mammography (special X-ray examination for the early detection of breast cancer). In addition, the enlarged breast can be a major psychological burden. Many people are afraid of ridicule and avoid certain situations, e.g. Swimming or sports. This can lead to inferiority complexes and even depression. It is therefore important that men who suffer severely from gynecomastia confide in their doctor and that a therapy can be found together.

Pain

In gynecomastia, the enlarged mammary gland and especially the nipple are more sensitive to touch than normal. Touching the chest area can also cause pain in those affected, but this is very rarely the case. Gynecomastia is usually not painful.

Cirrhosis of the liver

Cirrhosis of the liver is caused by inflammation of the liver or chronic alcohol consumption. This destroys the liver tissue and converts it into bone tissue structures. As a result, the liver can no longer fulfill its various functions, including breaking down sex hormones. All sex hormones are steroid hormones, which means that they are not soluble in water but only in fat and have to be broken down in the liver and excreted in the bile. In cirrhosis of the liver, estrogen, which is also found in men, accumulates and testosterone is increasingly converted into female sex hormones. As a result, the effects of estrogen predominate: the man "feminizes" and the mammary gland begins to grow.

Gynecomastia with a lump in the chest

Men who find their breasts are growing should definitely see a doctor who can examine the breast and rule out a malignant disease. In gynecomastia there is a pathological increase in mammary gland tissue. The excess tissue can be felt and is felt as a knot-like thickening under the nipple. Palpable lumps in the breast are therefore normal and harmless in gynecomastia, but it is essential to consult a doctor for clarification, as men can also develop breast cancer.

Read more on the topic: How to recognize breast cancer in men