Breast Reduction in Men With Gynecomastia

What is gynecomastia?

Gynecomastia is a condition in which the male's breast tissue enlarges. This increase in tissue usually occurs at times when the male is having hormonal changes, such as during infancy, adolescence, and old age.

What causes gynecomastia?

This is usually a benign (noncancerous) condition that may be caused by many different hormonal changes, or, in some cases, the cause may be unknown. The changes in hormones usually include an increase in estrogens or a decrease in androgens (testosterone). Sometimes, this condition may be associated with other diseases that must be ruled out in order to make a diagnosis. In some conditions, including breast cancer, liver diseases, lung cancer, testicular cancer, tumors of the adrenal glands or pituitary gland, drug use, certain congenital (present at birth) syndromes, or thyroid disorders or trauma, gynecomastia presents itself as a symptom. However, this is not true in all cases.

Facts about gynecomastia

Consider the following statistics regarding gynecomastia:

  • Most cases of gynecomastia occur during puberty, and the condition often will improve after two to three years without intervention.

  • Infants may have a transient form of the disease that is often related to the maternal hormones.

What are the symptoms of gynecomastia?

Gynecomastia is an increase in breast tissue. The condition may occur in one or both breasts and starts as a small lump beneath the nipple, which may be tender. The breasts often enlarge unevenly.

The symptoms of gynecomastia may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is gynecomastia diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for gynecomastia may include the following:

  • Blood tests (including liver function tests and hormone studies)

  • Urine tests

  • Consultation with an endocrinologist. A doctor who specializes in the functioning of hormones and how the hormones affect multiple organs.

  • Mammogram. A low-dose X-ray of the breast.

Treatment for gynecomastia

Specific treatment for gynecomastia will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Generally, treatment is not needed, and in some cases, hormone therapy may be used. Surgery may be an option to help remove the excess tissue. Often, if symptoms of gynecomastia are first apparent during puberty, it may be advised to wait as long as two years to allow for natural regression of the breast tissue. Your surgeon will help decide if you are a candidate for surgery.

About the surgery

The type of anesthesia used will depend on many factors, including your preference, the surgeon, the extent of the growth, your age, and the size of the incision. Either local with intravenous sedation or general anesthesia may be used. The surgeon often will make marks on the skin before surgery to indicate the areas to be removed.

There are different types of surgical procedures that may be utilized, including the following:

  • Suction lipectomy. This is a form of liposuction that allows for tapering of the edges of the tissue without unwanted side effects. Complicated gynecomastia conditions may require an open surgical procedure, in which the breast tissue is cut open and the excess tissue is removed.

  • Endoscopic surgery. This newer procedure uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of the breast. Tissue is then removed without making a large, open, surgical incision. Data regarding the accuracy or complications of this technique are not available at this time.