Maybe you’ve gained a little weight recently, or started a new medication. You look in the mirror and you see breasts, but here’s the catch: You’re a man. Is that normal?
Not entirely.
Gynecomastia—an overdevelopment of breast tissue in men—is not normal, but it’s also not particularly uncommon. Between 50 and 60 percent of adolescent boys have the condition, as do up to 70 percent of men between the ages of 50 and 69. According to the American Society of Plastic Surgeons, nearly 27,000 surgeries to correct gynecomastia were performed in 2017.
What Causes Gynecomastia?
Gynecomastia is caused by a hormonal imbalance between estrogen (commonly thought of as the female hormone) and testosterone (the male hormone). A number of things could be causing this imbalance, such as:
- Aging
- Medications
- Past alcohol, drug or anabolic steroid abuse
- Thyroid conditions
The list of drugs and medications for which gynecomastia is a possible side effect is extensive, and includes:
- Alcohol
- Anabolic steroids
- Benign prostatic hyperplasia (enlarged prostate) treatments
- Calcium channel blockers
- Chemotherapy treatments for cancer
- Digoxin
- HIV treatments
- Marijuana
- Opioids
- Tricyclic antidepressants
- Ulcer treatments
It is important to find the underlying cause of gynecomastia, because the condition could be indicative of a more serious health concern. Liver disease, kidney disease, breast cancer, adrenal tumors and testicular tumors can all cause hormonal imbalances that ca result in gynecomastia. Doctors will usually do a physical examination and take a medical history, and may run additional lab tests to rule out any potentially dangerous or life-threatening conditions causing the enlargement.
Is Gynecomastia Permanent?
It can be, but in this case “permanent’ does not mean “untreatable.” Many cases of gynecomastia go away on their own, like when it occurs in newborns and adolescents.
In newborns, estrogen from the mother may cause the breast tissue to temporarily grow. For boys entering puberty, there is a temporary increase in the conversion of testosterone into estrogen, but this is soon balanced out by an increase in testosterone production.
For all other cases, treatment is available.
What Are the Treatment Options?
First, it’s important to recognize whether you have gynecomastia or pseudogynecomastia. Pseudogynecomastia is a consequence of obesity. In pseudogynecomastia, the breast tissue is indistinguishable from other fatty tissue, and the whole area is enlarged. In gynecomastia, the enlargement is centered under the nipple area, and the tissue is firmer and rubbery.
Not everyone with gynecomastia—even persistent gynecomastia—needs surgery. There are medications available to treat gynecomastia, such as drugs that treat breast cancer and those that block the conversion of androgens (e.g., testosterone into estrogen). While all of these medications have been approved by the FDA, not all have been approved specifically for the treatment of gynecomastia. Nausea, weight gain, acne and abnormal liver function are some of the side effects of these drugs.
Should You Get Gynecomastia Surgery?
If you’re unwilling to wait for your gynecomastia to resolve itself and you don’t want to take medication, then it’s time to consider surgery. Gynecomastia surgery is a personal choice that requires careful thought.
It is important to know that if you’ve had gynecomastia for longer than six months to a year, medication might not help. That’s because fibrosis—the thickening and scarring of tissue—may have set in at that point, and medication will be less effective.
Choosing to have surgery to correct gynecomastia should be based on a number of factors. One of the most important considerations is how your gynecomastia makes you feel. Does it interfere with your daily life? Are you too embarrassed to leave the house? A 2015 review published in the journal Body Image suggests that men with gynecomastia can feel emasculated and develop anxiety, low self-esteem and depression. If gynecomastia is negatively affecting your mental health, surgery to correct the condition may help.
Another consideration is cost. Can you afford the surgery? According to the American Society of Plastic Surgeons, the average cost of gynecomastia surgery is more than $3,600. In most cases, gynecomastia surgery is not covered by insurance, but you can always check with your provider.
Lastly, are you comfortable with the risks and side effects of surgery? While gynecomastia is both safe and effective, any surgery carries certain risks, such as bleeding, infection at the incision site and adverse reaction to anesthesia. And, don’t forget about the temporary pain and discomfort immediately after the surgery.
Surgery can be an excellent way to feel better about your body if you currently have gynecomastia. If you feel it is right for you, we’d love to help. Contact us today for an appointment to discuss your treatment.
