Gynaecomastia is an abnormal condition characterized by breast enlargement in males. Occasionally these may also secrete milk. This condition may also be seen in neonates, adolescents and elderly individuals, as a part of physiological changes without needing any treatment.
Gynaecomastia can affect one or both the breasts. Generally gynaecomastia does not produce any harmful effect on the body but it may induce undue stress and embarrassment that can have psychological impact onthe active sex life of the affected individual. Male gynaecomastia can also cause psychological damage or loss of self-esteem in adolescents.
Causes of gynaecomastia
There are large numbers of causes responsible for development of gynaecomastia. Some of them are physiological (Part of the growing process) and does not need any treatment.
Physiological
- Newborn: Due to the presence of maternal hormones circulating in blood
- Adolescence: Due to hormonal changes which are temporary and may disappear as the hormonal levels stabilize
- Increased age and weight: Production of testosterone declines with age while fat cells stimulate the secretion of female hormone oestrogen
Pathological
The various pathological causes of gynaecomastia are as follows:
- Certain medication such as antipsychotics and anabolic steroids cause gynaecomastia as a side effect
- Increased levels of oestrogen due to various conditions such as obesity, hyperthyroidism, malnourishment, adrenal tumours and testicular tumours
- Decreased or lack of testosterone production due to conditions such as Klinefelter’s syndrome, viral orchitis and renal failure
- Chronic kidney or liver disease
- HIV infection
- Chronic illness
Idiopathic
Idiopathic means gynaecomastia without known cause. In this condition usually only one side is enlarged may need correction by surgery. This is common in adolescent ages.
Diagnosis
The diagnosis of gynaecomastia includes a physical examination of the patient, by the physician. Occasionally a mammogram may be ordered to confirm the diagnosis of gynaecomastia. Certain blood tests may also be conducted to evaluate the underlying cause of gynaecomastia.
Treatment
The non-surgical methods employed for management of gynaecomastia include:
- In case of drug induced gynaecomastia, replacement of the offending drug with an alternative and safer medication
- Medical treatment of the underlying disease conditions causing gynaecomastia
In patients not responding to non-surgical options, surgery is considered as the last option. The surgical methods for management of gynaecomastia include:
- Liposuction
- Gland excision
- Skin sculpture
- Reduction mammoplasty
- Combination of the surgical techniques mentioned above
The basic steps involved in surgery are as follows:
- The surgery can be performed under general or local anaesthesia
- The patient is anesthetized
- A small incision is made below the areola region of the breast
- Excessive breast tissue is surgically removed
- Excessive fat is removed by liposuction
- The incision is finally sutured
Normally the surgery takes about 90 minutes. After surgery patient are often advised to wear an elastic pressure garment or ace bandages that promote healing. Patients are also advised rehabilitation exercises for at least 3 weeks and can return to normal activities in 6 weeks.
Complications
The common complications associated with gynaecomastia surgery include:
- Infection
- Change in position or shape of the nipple
- Numbness
- Swelling
- Bruising
- Scarring
- Hematoma (accumulation of blood)
General Surgery
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