The commonest cause for bother regarding male breast is a condition of its abnormal enlargement called Gynecomastia or male boobs. If this affects you, read on to know more.
What is Gynecomastia?
Males can have female like enlargement of breasts. This problem is known as Gynecomastia or Male Boobs. It is a very frequent cause of distress in young males who develop a complex about their body and fear to expose themselves in public. This can lead to complex psychological problems with long lasting cosequences.
What causes Gynecomastia?
Gynecomastia is caused by hormonal imbalance. Most cases are seen around puberty. The hormonal milieu of the body changes around the time of puberty. If the estrogens rise more in proportion to testosterone, then the result can be Gynecomastia. Sometimes, the target tissues respond abnormally to normal levels of hormones and this again results in enlargement of breasts. All these patients are otherwise healthy boys who are completely normal. If the surgeon finds no abnormality on examination of the patient, then no detailed investigation is warranted.
Rarely gynecomastia may be secondary to genetic abnormalities or abnormally high levels of circulating sex hormones due to various reasons like, tumours, Liver disease, kidney disease or side effect of certain drugs or use of anabolic steroids.
Gynecomastia can come at different ages. Neonates may have breast enlargement because of circulating sex hormones from the mother but it reverses quickly. Elderly males can have it because of drugs, obesity or liver disease, kidney disease etc. The pubertal enlargement is the cause for maximum distress because it the time when individuals are very body conscious.
What are the symptoms and signs?
- Enlargement of breasts. It may or may not be symmetrical. This can be fatty or glandular or mixed.
The enlargement can be a mere button like presence of gland under the nipple area or it may make breasts as big as the fully developed female breast at the other end of the spectrum.
- Some patients can have pain, tenderness or heaviness in the area.
- Most patients seek help because they are too embarrassed by the condition rather than having any physical symptoms.
Is It necessary to treat this condition?
The condition can be left alone if the patient is asymptomatic and his examination does not detect any illness or abnormality in the body. Some patients can have reversal of gland enlargement with time but this is unlikely to happen after 17 years of age. After this age, correction is only possible surgically.
Will exercises or weight loss help?
Exercises help develop pectoral muscles and do not alter the breast size. Weight loss can help you shed kilos off entire body and some fat may come off from breasts as well, but the glandular component is not changed.
What are various treatment options?
There is no satisfactory medical treatment for this condition. Tamoxifen is prescribed, but it rarely helps. So only effective remedies are surgical.
1. Liposuction – is suitable for breasts with plenty of fat and little or no glandular tissue. [Pseudo Gynecomastia] It is done through 1-2 portsaround each breast by introducing hollow pipe like cannulas into breast and sucking out the excess fat tissues. Basic healing occurs in 7-10 days’ time and recovery occurs quickly. The patient wears a pressure garment after the procedure to help reduce edema and redraping of the tissues.
2. Excision – removes the hard glandular tissue which is difficult to suck otherwise. The gland is removed through a small half circle incision at the base of areola which heals without prominent scar as it is at a junction area. A negative suction drain is frequently inserted on each side till first dressing to avoid the collection of blood [hematoma] Healing time is about three weeks.
This procedure can be combined with liposuction.
3. Vaser Liposuction – can help suck out the gland which otherwise can be removed by open surgery only. It uses a probe which sends ultrasonic waves to disintegrate the tough glandular tissues which are then sucked away as in conventional liposuction. There can be greater postoperative pain and discharge. The machine is expensive and adds to the cost of procedure.
Is the growth cancerous?
No it is not. Yet all tissues removed are subjected to histology to detect any occult disease.
Will the removed tissues come back?
No. The breast tissue which is removed will not come back. It is gone for good!
What can be possible complications?
- Hematoma/ Infection
- Alterations in nipple sensation
- NA necrosis & healing problems
- Inadequate or over reduction
- Scar widening/ hypertrophy