Men can have breasts too! I don’t mean pecs, but femininelooking breasts. Some want them, while many men do not, especially when theymight be sagging, tender, lop sided, or cone shaped. There are three possiblecauses for enlargement of the male breasts: 1. gynecomastia, which is aproliferation of glandular tissue of the breast; 2. pseudogynecomastia, whichis an accumulation of fatty tissue surrounding the male breast; or, in rarecases, due to 3. breast cancer. The American Cancer Society estimates nearly2000 men will be diagnosed with breast cancer in the U.S. in 2008 resulting inabout 450 deaths.
In patients with true gynecomastia, a rubbery or firm andoften painful mass may be felt in the area directly surrounding the nipple,whereas in pseudogynecomastia the increase of the smooth, soft underlying fattissue may result in the look of enlarged breasts. Breast cancer is usuallyfelt as a hard or firm painless mass most often further away from the nipplearea and on one side of the chest. Breast tumors may be associated withdimpling of the skin, changes in the appearance of the nipple, crusting ordischarge of the nipple and swollen lymph nodes under the arms. Althoughsometimes seen only in one breast, gynecomastia and pseudogynecomastia are generallypresent in both breasts
Gynecomastia is the result of an imbalance of female(estrogen) to male (androgen) sex hormones at the level of breast tissue. Whenthe scale is tipped in favor of estrogen, there is a stimulating effect onbreast tissue. Gynecomastia is common during adolescence due to hormonalfluctuations, and the majority of these cases resolve without treatment. Inadulthood, 30% to 50% of males between the ages of 40 and 70 can present withgynecomastia, thought to be due to a combination of genetics, gradual decreasein testosterone level, and excess fatty tissue producing greaterestrogens. Furthermore, certaindrugs are implicated in causing gynecomastia; the most common include anabolicsteroids (used for bodybuilding or the treatment of medical conditions),HIV protease inhibitors, Propecia,certain cardiovascular and antihypertensive medications and some classes ofantidepressants or psychoactive drugs, alcohol, marijuana, amphetamines oropioids, and even too much soy (phytoestrogens). Although less common,testicular or adrenal tumors, thyroid, liver or kidney disease, and others maycause gynecomastia. For thisreason, it is recommended that all cases of gynecomastia or pseudogynecomastiashould be evaluated by a medical provider to rule out the possibility of aserious underlying illness and to determine the appropriate course oftreatment. Although the likelihoodof finding a pathologic abnormality is low among patients with long-standing,asymptomatic gynecomastia, a detailed medical history, complete physicalexamination and lab tests to measure hormone levels and kidney, liver andthyroid functions are prudent. Incases where breast enlargement is not typical of gynecomastia, a mammogram orfine-needle biopsy may be ordered to rule out breast cancer.
If a specific cause of gynecomastia can be identified andtreated early in the course of the condition, there may be some spontaneousdecrease in the breast enlargement. For example, if gynecomastia is drug-induced, there will generally bedecreased tenderness and softening of the glandular tissue within a month afterdiscontinuation of the drug. However, gynecomastia which has been present formore than one year is less likely to resolve spontaneously or with medicaltherapy due to the development of surrounding fibrous tissue. In these cases, surgical removal of thetissue or liposuction is often needed to reduce the size of the breast. Goodcosmetic outcomes have been demonstrated with liposuction of the male breast.These procedures can be safely and comfortably performed under local anesthesiaalong with oral sedation and pain medication, thereby minimizing the risksassociated with general anesthesia. Furthermore, tamoxifen (an estrogenblocker) has had some success in reversing gynecomastia.
While the majority of cases of male breast enlargement arebenign, the condition can cause embarrassment and significantly impact apatient’s lifestyle and self-image. It is important to seek treatment in asupportive and reassuring setting and remember to be sensitive to friends orloved-ones who may be dealing with this condition.
